Provider Demographics
NPI:1962254896
Name:MIKRES, SCOTT LEE (HAS)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:LEE
Last Name:MIKRES
Suffix:
Gender:M
Credentials:HAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1021 OAK FOREST LN
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29577-9795
Mailing Address - Country:US
Mailing Address - Phone:843-839-6616
Mailing Address - Fax:
Practice Address - Street 1:1021 OAK FOREST LN
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577-9795
Practice Address - Country:US
Practice Address - Phone:843-839-6616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-03
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCHAS0588332S00000X, 237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
No332S00000XSuppliersHearing Aid Equipment