Provider Demographics
NPI:1497031652
Name:OPTECH ORTHOTICS & PROSTHETICS SERVICES, LTD
Entity Type:Organization
Organization Name:OPTECH ORTHOTICS & PROSTHETICS SERVICES, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:B
Authorized Official - Last Name:MCNAB
Authorized Official - Suffix:JR
Authorized Official - Credentials:CPO
Authorized Official - Phone:815-932-8564
Mailing Address - Street 1:3900 W 95TH ST STE 7
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60805-1901
Mailing Address - Country:US
Mailing Address - Phone:815-932-8564
Mailing Address - Fax:
Practice Address - Street 1:3900 W 95TH ST
Practice Address - Street 2:
Practice Address - City:EVERGREEN PARK
Practice Address - State:IL
Practice Address - Zip Code:60805
Practice Address - Country:US
Practice Address - Phone:815-932-8564
Practice Address - Fax:815-932-8640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-01
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL6664850005OtherMEDICARE PTAN