Provider Demographics
NPI:1093945339
Name:COLORADO ORTHOTIC & PROSTHETIC SERVICES LLC
Entity Type:Organization
Organization Name:COLORADO ORTHOTIC & PROSTHETIC SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:NALDER
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:719-577-2533
Mailing Address - Street 1:8111 E LOWRY BLVD
Mailing Address - Street 2:STE 220
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80230-7193
Mailing Address - Country:US
Mailing Address - Phone:720-858-1111
Mailing Address - Fax:720-858-7052
Practice Address - Street 1:622 ELKTON DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-3514
Practice Address - Country:US
Practice Address - Phone:719-577-2533
Practice Address - Fax:720-858-7052
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COLORADO ORTHOTIC & PROSTHETIC SERVICES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-07-21
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO332B00000X
335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies