Provider Demographics
NPI:1720483076
Name:IRWIN, SHANE (HEARING AID DEALER)
Entity Type:Individual
Prefix:
First Name:SHANE
Middle Name:
Last Name:IRWIN
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 1:107 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:IRONTON
Mailing Address - State:OH
Mailing Address - Zip Code:45638-1471
Mailing Address - Country:US
Mailing Address - Phone:740-533-0077
Mailing Address - Fax:513-433-0126
Practice Address - Street 1:107 N 3RD ST
Practice Address - Street 2:
Practice Address - City:IRONTON
Practice Address - State:OH
Practice Address - Zip Code:45638-1471
Practice Address - Country:US
Practice Address - Phone:740-533-0077
Practice Address - Fax:513-433-0126
Is Sole Proprietor?:No
Enumeration Date:2014-10-29
Last Update Date:2014-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH10904237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter