Healthcare Provider Details

I. General information

NPI: 1508863689
Provider Name (Legal Business Name): LAFAYETTE ORTHOTICS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 SAINT LANDRY ST
LAFAYETTE LA
70506-4626
US

IV. Provider business mailing address

500 SAINT LANDRY ST
LAFAYETTE LA
70506-4626
US

V. Phone/Fax

Practice location:
  • Phone: 337-232-7647
  • Fax: 337-232-4021
Mailing address:
  • Phone: 337-232-7647
  • Fax: 337-232-4021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License NumberCO003825
License Number StateLA

VIII. Authorized Official

Name: MR. JOHN R. MOORE
Title or Position: OWNDER
Credential: C.O., B.O.C.
Phone: 337-232-7647