Provider Demographics
NPI:1891190351
Name:BLEVINS, GREG (HEARING AID DEALER)
Entity Type:Individual
Prefix:
First Name:GREG
Middle Name:
Last Name:BLEVINS
Suffix:
Gender:M
Credentials:HEARING AID DEALER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1203 13TH ST REAR
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41101-2607
Mailing Address - Country:US
Mailing Address - Phone:606-329-2644
Mailing Address - Fax:513-297-0746
Practice Address - Street 1:1203 13TH ST REAR
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-2607
Practice Address - Country:US
Practice Address - Phone:606-329-2644
Practice Address - Fax:513-297-0746
Is Sole Proprietor?:No
Enumeration Date:2014-10-27
Last Update Date:2014-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV701237700000X
KY0678237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist