Provider Demographics
NPI:1578548426
Name:LAKE NORMAN ORTHOTICS & PROSTHETICS, INC
Entity Type:Organization
Organization Name:LAKE NORMAN ORTHOTICS & PROSTHETICS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KURT
Authorized Official - Middle Name:F
Authorized Official - Last Name:BEYER
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:704-822-8005
Mailing Address - Street 1:1095 S HIGHWAY 16
Mailing Address - Street 2:
Mailing Address - City:STANLEY
Mailing Address - State:NC
Mailing Address - Zip Code:28164-8709
Mailing Address - Country:US
Mailing Address - Phone:704-822-8005
Mailing Address - Fax:704-822-8828
Practice Address - Street 1:1095 S HIGHWAY 16
Practice Address - Street 2:
Practice Address - City:STANLEY
Practice Address - State:NC
Practice Address - Zip Code:28164-8709
Practice Address - Country:US
Practice Address - Phone:704-822-8005
Practice Address - Fax:704-822-8828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-14
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2673332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7703034Medicaid
NC046AJOtherBCBS
NC6487083OtherCIGNA
NC046AJOtherBCBS