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General NPI Number Information
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NPI Number | 1326058058
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Entity Type | Organization
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Legal Business Name | EASTERN VA ORTHOTICS & PROSTHETICS, INC
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Dates
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Enumeration Date | 08/08/2006
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Last Update Date | 05/09/2024
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Provider Practice Location Address
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Address Line | 13394 CHESAPEAKE PL
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City | CARROLLTON
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State | VA
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Zip | 23314-3388
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Country | US
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Telephone | 757-850-2835
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Fax | 757-850-3409
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Provider Business Mailing Address
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Address Line | PO BOX 3511
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City | HAMPTON
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State | VA
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Zip | 23663-0511
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Country | US
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Telephone | 757-850-2835
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Fax | 757-850-3409
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Authorized Official
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Title or Position | OWNER/ADMIN
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Name | MISS LISA L CROUSE
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Credential |
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Telephone | 757-850-2835
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 222Z00000X
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Taxonomy Name | Orthotist
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License Number | C12887
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State |
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