Healthcare Provider Details

I. General information

NPI: 1245119247
Provider Name (Legal Business Name): KENNETH O'MEARA CPO, LPO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2025
Last Update Date: 09/02/2025
Certification Date: 09/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11809 DOMAIN DR UNIT 100
AUSTIN TX
78758-3452
US

IV. Provider business mailing address

428 ROPER ST
GEORGETOWN TX
78626-2637
US

V. Phone/Fax

Practice location:
  • Phone: 737-707-0058
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code222Z00000X
TaxonomyOrthotist
License Number1952
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number1952
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: