Healthcare Provider Details

I. General information

NPI: 1669863114
Provider Name (Legal Business Name): PROSTHETIC ARTISTS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2015
Last Update Date: 07/31/2024
Certification Date: 07/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2575 E BIDWELL ST STE 240
FOLSOM CA
95630-6447
US

IV. Provider business mailing address

2575 E BIDWELL ST STE 240
FOLSOM CA
95630-6447
US

V. Phone/Fax

Practice location:
  • Phone: 916-485-4249
  • Fax: 734-800-3723
Mailing address:
  • Phone: 916-485-4249
  • Fax: 734-800-3723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number07-322-13
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code156FX1700X
TaxonomyOcularist
License Number
License Number StateNULL

VIII. Authorized Official

Name: ERIC MATTHEW LINDSEY
Title or Position: PRESIDENT/CEO
Credential:
Phone: 916-485-4249