Provider Demographics
NPI:1649301094
Name:PRO EAR INC.
Entity type:Organization
Organization Name:PRO EAR INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:HAYNES
Authorized Official - Suffix:
Authorized Official - Credentials:BC, NBC-HIS AUDIOP
Authorized Official - Phone:815-988-1830
Mailing Address - Street 1:801 N. PERRYVILLE RD
Mailing Address - Street 2:SUITE #2
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-6232
Mailing Address - Country:US
Mailing Address - Phone:815-397-4327
Mailing Address - Fax:815-397-4341
Practice Address - Street 1:801 N. PERRYVILLE RD
Practice Address - Street 2:SUITE #2
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-6232
Practice Address - Country:US
Practice Address - Phone:815-397-4327
Practice Address - Fax:815-397-4341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Multi-Specialty
No332S00000XSuppliersHearing Aid EquipmentGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL330500518001Medicaid