Organization
OQUIRRH MOUNTAIN HEARING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JUSTIN DUANE LITTLEDIKE (OWNER/BC-HIS)
(801) 633-5196
Entity
Organization
Contact information
Practice address
134 W 1180 N STE 5, TOOELE, UT 84074-1483
(435) 248-2842
(385) 202-0542
Mailing address
506 N COOLEY ST, GRANTSVILLE, UT 84029-9359
(801) 633-5196
(385) 202-0542
Taxonomy
Speciality
Code
Description
License number
State
237700000X
Hearing Instrument Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10297571-4602
BC-HIS- LICENSE NUMBER
UT
Enumeration date
04/15/2019
Last updated
04/15/2019
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