Provider Demographics
NPI:1760561369
Name:COMMONWEALTH ORTHOTICS & PROSTHETICS
Entity Type:Organization
Organization Name:COMMONWEALTH ORTHOTICS & PROSTHETICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:THEODORE
Authorized Official - Middle Name:NICHOLAS
Authorized Official - Last Name:ARGYRAKIS
Authorized Official - Suffix:II
Authorized Official - Credentials:CERTIFIED PROTHETIST
Authorized Official - Phone:434-836-4736
Mailing Address - Street 1:413 MOUNT CROSS RD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24541-9999
Mailing Address - Country:US
Mailing Address - Phone:434-836-4736
Mailing Address - Fax:434-836-6208
Practice Address - Street 1:413 MOUNT CROSS RD
Practice Address - Street 2:SUITE 107
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24541-9999
Practice Address - Country:US
Practice Address - Phone:434-836-4736
Practice Address - Fax:434-836-6208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2015-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA009190864Medicaid
063164OtherANTHEM BCBS
VA009190864Medicaid