Provider Demographics
NPI:1609957307
Name:DOVE ORTHOTICS, INC
Entity Type:Organization
Organization Name:DOVE ORTHOTICS, INC
Other - Org Name:DOVE MEDICAL SUPPLIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORETTA
Authorized Official - Middle Name:
Authorized Official - Last Name:CARR-STOCK
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:716-688-8911
Mailing Address - Street 1:4114 UNION RD
Mailing Address - Street 2:
Mailing Address - City:CHEEKTOWAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14225-3406
Mailing Address - Country:US
Mailing Address - Phone:716-688-8911
Mailing Address - Fax:716-688-9193
Practice Address - Street 1:4114 UNION RD
Practice Address - Street 2:
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14225-3406
Practice Address - Country:US
Practice Address - Phone:716-688-8911
Practice Address - Fax:716-688-9193
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
000551319002OtherBLUE CROSS & BLUE SHIELD
8201188OtherEVERCARE
NY02094842Medicaid
00030419702OtherUNIVERA
8290806OtherINDEPENDENT HEALTH
1271690001Medicare ID - Type Unspecified