| NPI | 1740597202 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES STANLEY DAVIS Orthotist 757-802-3210 |
| Organization Subpart ? | No |
| Primary Taxonomy | 335E00000X Prosthetic/Orthotic Supplier (Licence: VA 2018-2468-21-R) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: VA 246821-R) |
| Enumeration Date | 2010-09-06 |
| Last Update Date | 2018-08-28 |