Organization
TIDEWATER HEARING CENTER
Active
Other names
Miracle Ear
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JANET IVENS (OWNER)
(757) 825-9477
Entity
Organization
Contact information
Practice address
5200 MERCURY BLVD, SEARS, SUITE 100, NEWPORT NEWS, VA 23605-1445
(757) 825-9477
Mailing address
2555 COVE POINT PL, VIRGINIA BEACH, VA 23454-3271
(757) 825-9477
(757) 825-9139
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
03231
VA
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
124122
VA
332B00000X
Durable Medical Equipment & Medical Supplies
14763800005200
VA
Other
Enumeration date
10/30/2014
Last updated
10/31/2014
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