Provider Demographics
NPI:1790068864
Name:EDMOND HEARING DOCTORS PLLC
Entity Type:Organization
Organization Name:EDMOND HEARING DOCTORS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUDIOLOGIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TREVOR
Authorized Official - Middle Name:
Authorized Official - Last Name:COUROULEAU
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:405-341-1800
Mailing Address - Street 1:307 E DANFORTH RD
Mailing Address - Street 2:SUITE 118
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-4483
Mailing Address - Country:US
Mailing Address - Phone:405-341-1800
Mailing Address - Fax:
Practice Address - Street 1:307 E DANFORTH RD
Practice Address - Street 2:SUITE 118
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-4483
Practice Address - Country:US
Practice Address - Phone:405-341-1800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-24
Last Update Date:2011-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK351261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech