MEDICARE: BUCKEYE ORTHOPEDIC DESIGN, INC.

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	222Z00000X	Orthotist	LPO 9	OH
2	335E00000X	Prosthetic/Orthotic Supplier	LPO 9	OH
3	224P00000X	Prosthetist	LPO 9	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1669550695
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BUCKEYE ORTHOPEDIC DESIGN, INC.

Provider Business Mailing Address
First Line	:	3187 WESTERN ROW RD
Second Line	:	SUITE 106
City	:	MAINEVILLE
State	:	OH
Zip	:	45039-8045
Country	:	US
Telephone Number	:	513-770-5550
Fax Number	:	513-770-4190

Provider Business Practice Location Address
First Line	:	3187 WESTERN ROW RD
Second Line	:	SUITE 106
City	:	MAINEVILLE
State	:	OH
Zip	:	45039-8045
Country	:	US
Telephone Number	:	513-770-5550
Fax Number	:	513-770-4190

Authorized Official
Title or Position	:	PRESIDENT CLINICAL DIRECTOR
Name	:	MR. MARK BONDURANT
Credential	:	CPO, LPO
Telephone Number	:	513-770-5550

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	01/22/2014

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Directions to “BUCKEYE ORTHOPEDIC DESIGN, INC. ” Practice Location

Language	Start Address	Practice Location

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