MEDICARE: OTTO BOCK ORTHOPEDIC SERVICES LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	222Z00000X	Orthotist
3	332BC3200X	Customized Equipment (DME)
4	224P00000X	Prosthetist
5	335E00000X	Prosthetic/Orthotic Supplier

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1001707	OTHER	TX	DEVICE DISTRIBUTOR LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MP01413	OTHER	NV	NV STATE BOP-MEDICAL DEVICES, EQUIPMENT, GAS
4	R4009	OTHER	MD	MD DEPT OF HEALTH & MENTAL HYGIENE-RESIDENTIAL SERVICE AGENCY

General Provider Information

NPI Number	:	1740515782
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OTTO BOCK ORTHOPEDIC SERVICES LLC

Provider Business Mailing Address
First Line	:	PO BOX 734949
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75373-4949
Country	:	US
Telephone Number	:	800-736-8276
Fax Number	:	866-642-2302

Provider Business Practice Location Address
First Line	:	525 ROUND ROCK WEST DR STE E213
Second Line	:
City	:	ROUND ROCK
State	:	TX
Zip	:	78681-5020
Country	:	US
Telephone Number	:	800-736-8276
Fax Number	:	866-642-2302

Authorized Official
Title or Position	:	EVP OF LICENSURE
Name	:	KIMBERLY LEWIS
Credential	:
Telephone Number	:	512-806-2756

Provider Enumeration Date	:	10/08/2009
Last Update Date	:	01/06/2026

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Directions to “OTTO BOCK ORTHOPEDIC SERVICES LLC ” Practice Location

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