Healthcare Provider Details

I. General information

NPI: 1407961618
Provider Name (Legal Business Name): ORTHOCARE ORTHOTICS AND PROSTHETICS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 01/21/2026
Certification Date: 01/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

379 FENNELL BLVD
LADY LAKE FL
32159-3185
US

IV. Provider business mailing address

PO BOX 207
LADY LAKE FL
32158-0207
US

V. Phone/Fax

Practice location:
  • Phone: 352-751-7265
  • Fax: 352-751-4447
Mailing address:
  • Phone: 352-751-7265
  • Fax: 352-751-4447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number1312064
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License NumberORT 61
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License NumberPRO91
License Number StateFL

VIII. Authorized Official

Name: MR. MICHAEL PATRICK ODONELL
Title or Position: ORTHOTIST PRESIDENT
Credential: CO
Phone: 352-787-0065