Provider Demographics
NPI:1750661005
Name:JOHN IMM PROSTHETICS, LLC
Entity Type:Organization
Organization Name:JOHN IMM PROSTHETICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCULARIST/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:TOBY
Authorized Official - Last Name:IMM
Authorized Official - Suffix:
Authorized Official - Credentials:BCO
Authorized Official - Phone:850-380-8184
Mailing Address - Street 1:5593 STEWART ST
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:FL
Mailing Address - Zip Code:32570-4344
Mailing Address - Country:US
Mailing Address - Phone:850-380-8184
Mailing Address - Fax:
Practice Address - Street 1:3 W GARDEN ST STE 404
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32502-5633
Practice Address - Country:US
Practice Address - Phone:850-380-8184
Practice Address - Fax:850-434-1830
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-18
Last Update Date:2019-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier