| NPI | 1972326163 |
|---|---|
| Doing Business As | GREAT LAKES O AND P |
| Entity Type | Organization |
| Authorized Contact | TYNESHIA L MCFARLAND-WILLIAMS Employee 601-594-2801 |
| Organization Subpart ? | No |
| Primary Taxonomy | 335E00000X Prosthetic/Orthotic Supplier |
| Additional Taxonomies | 225000000X Orthotic Fitter |
| 332B00000X Durable Medical Equipment & Medical Supplies | |
| Enumeration Date | 2024-11-05 |
| Last Update Date | 2024-11-05 |