Provider Demographics
NPI:1922441518
Name:CARMEL ORTHODESIGN, LLC
Entity Type:Organization
Organization Name:CARMEL ORTHODESIGN, LLC
Other - Org Name:ORTHO DESIGN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SOLE MEMBER / ORTHOTIST
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:BRYANT
Authorized Official - Last Name:HODGE
Authorized Official - Suffix:
Authorized Official - Credentials:CO
Authorized Official - Phone:317-407-7049
Mailing Address - Street 1:9591 VALPARAISO CT
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-1130
Mailing Address - Country:US
Mailing Address - Phone:317-218-4270
Mailing Address - Fax:317-218-4271
Practice Address - Street 1:9591 VALPARAISO CT
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46268-1130
Practice Address - Country:US
Practice Address - Phone:317-218-4270
Practice Address - Fax:317-218-4271
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-12
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201194350AMedicaid
IN6841110001Medicare NSC