MEDICARE: LUMEN ORTHOTICS & PROSTHETICS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332BC3200X	Customized Equipment (DME)
2	335E00000X	Prosthetic/Orthotic Supplier

General Provider Information

NPI Number	:	1205680238
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LUMEN ORTHOTICS & PROSTHETICS

Provider Business Mailing Address
First Line	:	8902 STOCKBRIDGE PL
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46804-3454
Country	:	US
Telephone Number	:	460-450-4999
Fax Number	:

Provider Business Practice Location Address
First Line	:	8902 STOCKBRIDGE PL
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46804-3454
Country	:	US
Telephone Number	:	460-450-4999
Fax Number	:

Authorized Official
Title or Position	:	CERTIFIED ORTHOTIST
Name	:	MR. CHRISTOPHER T GEORGE
Credential	:	CO
Telephone Number	:	260-450-4999

Provider Enumeration Date	:	04/16/2024
Last Update Date	:	01/22/2025

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