Provider Demographics
NPI:1376876250
Name:OPTECH ORTHOTICS & PROSTHETICS, INC.
Entity Type:Organization
Organization Name:OPTECH ORTHOTICS & PROSTHETICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-932-8564
Mailing Address - Street 1:138 N SCHUYLER AVE
Mailing Address - Street 2:
Mailing Address - City:KANKAKEE
Mailing Address - State:IL
Mailing Address - Zip Code:60901-3829
Mailing Address - Country:US
Mailing Address - Phone:815-932-8564
Mailing Address - Fax:815-932-8640
Practice Address - Street 1:200 LAIRD LN
Practice Address - Street 2:
Practice Address - City:WATSEKA
Practice Address - State:IL
Practice Address - Zip Code:60970-7568
Practice Address - Country:US
Practice Address - Phone:815-432-7783
Practice Address - Fax:815-932-8640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-10
Last Update Date:2009-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
IL1245500001Medicare NSC