Provider Demographics
NPI:1669471009
Name:CENTRAL OHIO ORTHOTIC & PROSTHETIC CTR INC
Entity Type:Organization
Organization Name:CENTRAL OHIO ORTHOTIC & PROSTHETIC CTR INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:P
Authorized Official - Last Name:FOWLER
Authorized Official - Suffix:SR
Authorized Official - Credentials:ORTHOTIST/PROSTHETIS
Authorized Official - Phone:614-231-4256
Mailing Address - Street 1:3059 E MOUND ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43209-2665
Mailing Address - Country:US
Mailing Address - Phone:614-231-4256
Mailing Address - Fax:614-231-0127
Practice Address - Street 1:3059 E MOUND ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43209-2665
Practice Address - Country:US
Practice Address - Phone:614-231-4256
Practice Address - Fax:614-231-0127
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0820553Medicaid
OH000000155144OtherANTHEM BCBS
OH0820553Medicaid
OH000000155144OtherANTHEM BCBS