Provider Demographics
NPI:1891708830
Name:EASTWOOD ORTHOTICS, INC.
Entity Type:Organization
Organization Name:EASTWOOD ORTHOTICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:R
Authorized Official - Last Name:BYERS
Authorized Official - Suffix:
Authorized Official - Credentials:CO, CP
Authorized Official - Phone:724-981-5688
Mailing Address - Street 1:701 N HERMITAGE RD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:HERMITAGE
Mailing Address - State:PA
Mailing Address - Zip Code:16148-3234
Mailing Address - Country:US
Mailing Address - Phone:724-981-5688
Mailing Address - Fax:724-981-5686
Practice Address - Street 1:701 N HERMITAGE RD
Practice Address - Street 2:SUITE 5
Practice Address - City:HERMITAGE
Practice Address - State:PA
Practice Address - Zip Code:16148-3234
Practice Address - Country:US
Practice Address - Phone:724-981-5688
Practice Address - Fax:724-981-5686
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0599820001Medicare NSC
PA0599820002Medicare NSC