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General NPI Number Information
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NPI Number | 1457922502
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Entity Type | Organization
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Legal Business Name | OPTIMUM PROSTHETICS & ORTHOTICS
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Dates
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Enumeration Date | 07/08/2021
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Last Update Date | 04/27/2022
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Provider Practice Location Address
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Address Line | 7345 W SAND LAKE RD STE 220
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City | ORLANDO
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State | FL
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Zip | 32819-5280
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Country | US
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Telephone | 321-446-8781
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Fax |
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Provider Business Mailing Address
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Address Line | 7345 W SAND LAKE RD STE 220
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City | ORLANDO
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State | FL
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Zip | 32819-5280
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Country | US
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Telephone | 321-446-8781
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Fax |
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Authorized Official
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Title or Position | CERTIFIED PROSTHETIST ORTHOTIST
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Name | MR. DUSTIN ARNOLD BROOKS
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Credential | MSPO, LPO, CPO
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Telephone | 321-446-8781
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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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