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General NPI Number Information
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NPI Number | 1881756674
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Entity Type | Organization
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Legal Business Name | PRECISION ORTHOTIC LABORATORIES, INC.
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Dates
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Enumeration Date | 12/15/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1057 R ST
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City | FRESNO
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State | CA
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Zip | 93721-1312
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Country | US
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Telephone | 559-441-7282
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Fax | 559-441-7209
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Provider Business Mailing Address
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Address Line | 1057 R ST
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City | FRESNO
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State | CA
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Zip | 93721-1312
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Country | US
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Telephone | 559-441-7282
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Fax | 559-441-7209
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. BRIAN KEVIN CROWDER SR.
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Credential | CO
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Telephone | 559-441-7282
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number | CO003684
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License Number State | CA
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