Provider Demographics
NPI:1689389967
Name:LEDFORD, EDDIE L JR (BC-HIS)
Entity Type:Individual
Prefix:
First Name:EDDIE
Middle Name:L
Last Name:LEDFORD
Suffix:JR
Gender:M
Credentials:BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:727 J CLYDE MORRIS BLVD STE F
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23601-1532
Mailing Address - Country:US
Mailing Address - Phone:757-596-2113
Mailing Address - Fax:
Practice Address - Street 1:727 J CLYDE MORRIS BLVD STE F
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23601-1532
Practice Address - Country:US
Practice Address - Phone:757-596-2113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-20
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2101000480237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist