Provider Demographics
NPI:1407961618
Name:ORTHOCARE ORTHOTICS AND PROSTHETICS INC
Entity Type:Organization
Organization Name:ORTHOCARE ORTHOTICS AND PROSTHETICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHOTIST PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:ODONELL
Authorized Official - Suffix:
Authorized Official - Credentials:CO
Authorized Official - Phone:352-787-0065
Mailing Address - Street 1:PO BOX 491558
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34749-1558
Mailing Address - Country:US
Mailing Address - Phone:352-787-0065
Mailing Address - Fax:352-787-3663
Practice Address - Street 1:1501 N US HIGHWAY 441
Practice Address - Street 2:BLDG 1100 STE 1108
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32159-6800
Practice Address - Country:US
Practice Address - Phone:352-751-7265
Practice Address - Fax:352-751-4447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2018-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1312064332B00000X
FLORT 61335E00000X
FLPRO91335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL022881800Medicaid
FL4174700001Medicare NSC