MEDICARE: OLD DOMINION PROSTHETICS & ORTHOTICS, 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	332BC3200X	Customized Equipment (DME)		VA

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
2	106977	OTHER	VA	ANTHEM

General Provider Information

NPI Number	:	1811095516
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OLD DOMINION PROSTHETICS & ORTHOTICS, INC.

Provider Business Mailing Address
First Line	:	1920 MEDICAL AVE
Second Line	:	SUITE G
City	:	HARRISONBURG
State	:	VA
Zip	:	22801-8016
Country	:	US
Telephone Number	:	540-433-3831
Fax Number	:	540-433-5447

Provider Business Practice Location Address
First Line	:	1920 MEDICAL AVE
Second Line	:	SUITE G
City	:	HARRISONBURG
State	:	VA
Zip	:	22801-8016
Country	:	US
Telephone Number	:	540-433-3831
Fax Number	:	540-433-5447

Authorized Official
Title or Position	:	BUSINESS MANAGER
Name	:	MRS. CATHERINE B GARRISON
Credential	:
Telephone Number	:	434-973-6209

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	07/21/2022

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