Healthcare Provider Details

I. General information

NPI: 1447366869
Provider Name (Legal Business Name): ROUND ROCK ORTHOTICS & PROSTHETICS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 12/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2911 MEDICAL ARTS ST BUILDING 7
AUSTIN TX
78705-3376
US

IV. Provider business mailing address

555 ROUND ROCK WEST DR BLDG D SUITE 100
ROUND ROCK TX
78681-5052
US

V. Phone/Fax

Practice location:
  • Phone: 512-341-3700
  • Fax:
Mailing address:
  • Phone: 512-341-3700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number101272
License Number StateTX

VIII. Authorized Official

Name: MR. ERIK ROY OLSON
Title or Position: PRESIDENT
Credential: LPO
Phone: 512-341-3700