Provider Demographics
NPI:1689070823
Name:TAEDS ORTOTICS & PROSTHETICS
Entity Type:Organization
Organization Name:TAEDS ORTOTICS & PROSTHETICS
Other - Org Name:TAED STUDER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CPO / OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TAED
Authorized Official - Middle Name:
Authorized Official - Last Name:STUDER
Authorized Official - Suffix:
Authorized Official - Credentials:CPO 1053
Authorized Official - Phone:805-710-1947
Mailing Address - Street 1:145 S HALCYON RD
Mailing Address - Street 2:# B,
Mailing Address - City:ARROYO GRANDE
Mailing Address - State:CA
Mailing Address - Zip Code:93420-3151
Mailing Address - Country:US
Mailing Address - Phone:805-710-1947
Mailing Address - Fax:
Practice Address - Street 1:145 S HALCYON RD
Practice Address - Street 2:# B,
Practice Address - City:ARROYO GRANDE
Practice Address - State:CA
Practice Address - Zip Code:93420-3151
Practice Address - Country:US
Practice Address - Phone:805-710-1947
Practice Address - Fax:805-473-8230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-17
Last Update Date:2014-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1346439932OtherNPI
CA1346439932OtherNPI