Provider Demographics
NPI:1245571660
Name:NV ORTHOTICS
Entity Type:Organization
Organization Name:NV ORTHOTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ORTHOTIST
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:NOVAK
Authorized Official - Suffix:
Authorized Official - Credentials:CO
Authorized Official - Phone:708-651-2564
Mailing Address - Street 1:5131 ELLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:WESTERN SPRINGS
Mailing Address - State:IL
Mailing Address - Zip Code:60558-2034
Mailing Address - Country:US
Mailing Address - Phone:708-651-2564
Mailing Address - Fax:
Practice Address - Street 1:1675 W DEMPSTER ST
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-1110
Practice Address - Country:US
Practice Address - Phone:708-651-2564
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-11
Last Update Date:2013-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL04254422335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier