Provider Demographics
NPI:1942964150
Name:ORTHOTIC AND PROSTHETIC CLINICS OF AMERICA
Entity Type:Organization
Organization Name:ORTHOTIC AND PROSTHETIC CLINICS OF AMERICA
Other - Org Name:OPCA CLINICS OF TAMPA
Other - Org Type:Other Name
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:L
Authorized Official - Last Name:ANTUNA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-777-2396
Mailing Address - Street 1:4809 MEMORIAL HWY STE 100
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634-7515
Mailing Address - Country:US
Mailing Address - Phone:813-728-4660
Mailing Address - Fax:813-466-5026
Practice Address - Street 1:4809 MEMORIAL HWY STE 100
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33634-7515
Practice Address - Country:US
Practice Address - Phone:813-466-5006
Practice Address - Fax:813-466-5026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-25
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment