Provider Demographics
NPI:1215145677
Name:MIRACLE EAR
Entity type:Organization
Organization Name:MIRACLE EAR
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:HEARING AID FITTER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:L
Authorized Official - Last Name:HEAFEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-737-0227
Mailing Address - Street 1:1700 STONERIDGE MALL RD
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94588-3271
Mailing Address - Country:US
Mailing Address - Phone:925-737-0227
Mailing Address - Fax:925-924-0130
Practice Address - Street 1:1700 STONERIDGE MALL RD
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94588-3271
Practice Address - Country:US
Practice Address - Phone:925-737-0227
Practice Address - Fax:925-924-0130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHT 8249237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty