Provider Demographics
NPI:1801850474
Name:CERTIFIED PROSTHETICS & ORTHOTICS, INC.
Entity Type:Organization
Organization Name:CERTIFIED PROSTHETICS & ORTHOTICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RAY
Authorized Official - Middle Name:D
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:CPO, LPO
Authorized Official - Phone:361-575-2877
Mailing Address - Street 1:PO BOX 4646
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77903-4646
Mailing Address - Country:US
Mailing Address - Phone:361-575-2877
Mailing Address - Fax:361-575-5111
Practice Address - Street 1:304 GEMINI CT
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-2679
Practice Address - Country:US
Practice Address - Phone:361-575-2877
Practice Address - Fax:361-575-5111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX519219OtherBCBSTX
TX5374410OtherAETNA
TX519219OtherBCBSTX