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General NPI Number Information
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NPI Number | 1508155870
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Entity Type | Individual
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Provider Name | JOSEPH CHRISTOPHER LAKE L/CPO, FAAOP
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Gender | Male
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Dates
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Enumeration Date | 04/07/2011
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Last Update Date | 09/01/2011
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Provider Practice Location Address
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Address Line | 350 WESTPARK WAY SUITE 108
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City | EULESS
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State | TX
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Zip | 76040-3964
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Country | US
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Telephone | 817-358-1500
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Fax | 682-224-8430
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Provider Business Mailing Address
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Address Line | 350 WESTPARK WAY SUITE 108
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City | EULESS
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State | TX
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Zip | 76040-3964
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Country | US
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Telephone | 817-358-1500
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Fax | 682-224-8430
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 80
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 224P00000X
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Taxonomy Name | Prosthetist
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License Number | 80
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License Number State | TX
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