Basic Information
| Provider Information | |||||||||
| NPI: | 1750464137 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DAVIS | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | WALTER | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | NIS-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8 WINDSHIRE DR | ||||||||
| Address2: | |||||||||
| City: | SOUTH WINDSOR | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060742134 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8606443167 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1362 HOPMEADOW ST | ||||||||
| Address2: | |||||||||
| City: | SIMSBURY | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060701411 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8606581922 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/23/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237700000X | 000340 | CT | Y | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist |
No ID Information.