Provider Demographics
NPI:1457324899
Name:ORTHOTIC CENTER, INC.
Entity Type:Organization
Organization Name:ORTHOTIC CENTER, INC.
Other - Org Name:ORTHOCONCEPTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KEN
Authorized Official - Middle Name:
Authorized Official - Last Name:GREENE
Authorized Official - Suffix:
Authorized Official - Credentials:CO
Authorized Official - Phone:440-528-8222
Mailing Address - Street 1:31100 SOLON RD
Mailing Address - Street 2:PO BOX 39415
Mailing Address - City:SOLON
Mailing Address - State:OH
Mailing Address - Zip Code:44139-3462
Mailing Address - Country:US
Mailing Address - Phone:440-528-8222
Mailing Address - Fax:440-528-8228
Practice Address - Street 1:31100 SOLON RD
Practice Address - Street 2:
Practice Address - City:SOLON
Practice Address - State:OH
Practice Address - Zip Code:44139-2843
Practice Address - Country:US
Practice Address - Phone:440-528-8222
Practice Address - Fax:440-528-8228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-08
Last Update Date:2011-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0480500Medicaid
CT004229979Medicaid
OH000000155524OtherANTHEM BCBS
MI4434706Medicaid
CT004229979Medicaid