Provider Demographics
NPI:1124569256
Name:EVOLUTION ORTHOTICS INC
Entity Type:Organization
Organization Name:EVOLUTION ORTHOTICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:DRAZEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-688-2860
Mailing Address - Street 1:501 GORDON ST
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-6327
Mailing Address - Country:US
Mailing Address - Phone:407-688-2860
Mailing Address - Fax:321-257-1987
Practice Address - Street 1:501 GORDON ST
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771-6327
Practice Address - Country:US
Practice Address - Phone:407-688-2860
Practice Address - Fax:321-257-1987
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-08
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies