Healthcare Provider Details

I. General information

NPI: 1366749855
Provider Name (Legal Business Name): O & P OPTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2011
Last Update Date: 02/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10547 MONTGOMERY RD SUITE 600
MONTGOMERY OH
45242-4418
US

IV. Provider business mailing address

10547 MONTGOMERY RD SUITE 600
MONTGOMERY OH
45242-4418
US

V. Phone/Fax

Practice location:
  • Phone: 513-791-7767
  • Fax: 513-791-7765
Mailing address:
  • Phone: 513-791-7767
  • Fax: 513-791-7765

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224P00000X
TaxonomyProsthetist
License NumberLPO-158
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code222Z00000X
TaxonomyOrthotist
License NumberLPO-158
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License NumberLPO158
License Number StateOH

VIII. Authorized Official

Name: MR. DOUGLAS BRIAN VAN ATTA
Title or Position: PRESIDENT
Credential: CPO/LPO
Phone: 513-702-5945