Provider Demographics
NPI:1639252869
Name:OPA 1, LTD
Entity Type:Organization
Organization Name:OPA 1, LTD
Other - Org Name:ORTHOTIC & PROSTHETIC ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:D
Authorized Official - Last Name:HOLYFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-797-0011
Mailing Address - Street 1:7301 FANNIN ST STE B
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-4807
Mailing Address - Country:US
Mailing Address - Phone:713-797-0011
Mailing Address - Fax:713-797-0010
Practice Address - Street 1:850 FM 1960 RD W STE H
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090-3413
Practice Address - Country:US
Practice Address - Phone:281-444-3335
Practice Address - Fax:281-444-6366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332BC3200X
TX101215335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX101215OtherSTATE LICENSE
TX1276680005Medicare NSC