Provider Demographics
NPI:1659650448
Name:MARY DUVAL HEARING AID CENTER
Entity Type:Organization
Organization Name:MARY DUVAL HEARING AID CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:HELEN
Authorized Official - Last Name:DUVAL
Authorized Official - Suffix:
Authorized Official - Credentials:IA LICENSE #466
Authorized Official - Phone:563-386-2986
Mailing Address - Street 1:1220 E. 37TH STREET
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-1901
Mailing Address - Country:US
Mailing Address - Phone:563-386-2986
Mailing Address - Fax:563-386-2991
Practice Address - Street 1:1220 E. 37TH STREET
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-1901
Practice Address - Country:US
Practice Address - Phone:563-386-2986
Practice Address - Fax:563-386-2991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-10
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA466237700000X, 332B00000X, 332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332S00000XSuppliersHearing Aid EquipmentGroup - Single Specialty