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General NPI Number Information
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NPI Number | 1336242544
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Entity Type | Organization
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Legal Business Name | O & P CUSTOM, LLC
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Dates
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Enumeration Date | 09/06/2006
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Last Update Date | 01/11/2010
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Provider Practice Location Address
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Address Line | 939 S DECATUR BLVD
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City | LAS VEGAS
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State | NV
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Zip | 89107-3918
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Country | US
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Telephone | 702-270-3200
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Fax | 702-870-3203
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Provider Business Mailing Address
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Address Line | 939 S DECATUR BLVD
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City | LAS VEGAS
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State | NV
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Zip | 89107-3918
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Country | US
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Telephone | 702-270-3200
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Fax | 702-870-3203
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Authorized Official
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Title or Position | CP AND MANAGING MEMBER
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Name | MR. DARREN R DAVIS
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Credential | CP 002814
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Telephone | 702-270-3200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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