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General NPI Number Information
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NPI Number | 1962423061
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Entity Type | Organization
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Legal Business Name | EASTWOOD ORTHOTICS, INC
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Dates
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Enumeration Date | 07/22/2006
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Last Update Date | 07/12/2016
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Provider Practice Location Address
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Address Line | 3877 YOUNGSTOWN RD SE
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City | WARREN
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State | OH
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Zip | 44484-2836
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Country | US
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Telephone | 330-544-6777
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Fax | 330-544-9366
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Provider Business Mailing Address
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Address Line | 3877 YOUNGSTOWN RD SE
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City | WARREN
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State | OH
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Zip | 44484-2836
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Country | US
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Telephone | 330-544-6777
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Fax | 330-544-9366
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. DENNIS R BYERS
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Credential | CO
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Telephone | 330-544-6777
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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 | CO003383
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License Number State | OH
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