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General NPI Number Information
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NPI Number | 1417962275
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Entity Type | Organization
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Legal Business Name | CENTRAL BRACE COMPANY
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Dates
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Enumeration Date | 07/30/2006
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Last Update Date | 09/10/2009
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Provider Practice Location Address
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Address Line | 404 PORTLAND ST REAR ENTRANCE EYE RESEARCH FOUNDATION
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City | COLUMBIA
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State | MO
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Zip | 65201-6506
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Country | US
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Telephone | 573-874-0321
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Fax | 573-874-2003
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Provider Business Mailing Address
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Address Line | 404 PORTLAND ST REAR ENTRANCE EYE RESEARCH FOUNDATION
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City | COLUMBIA
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State | MO
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Zip | 65201-6506
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Country | US
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Telephone | 573-874-0321
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Fax | 573-874-2003
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | GERALD WESTON BENEDICT
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Credential | B.O.C.O., C. PED.
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Telephone | 573-874-0321
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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 | MO
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