Provider Demographics
NPI:1952477101
Name:PROSTHETIC ILLUSIONS INC
Entity Type:Organization
Organization Name:PROSTHETIC ILLUSIONS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:S
Authorized Official - Last Name:LILLO
Authorized Official - Suffix:
Authorized Official - Credentials:CCA
Authorized Official - Phone:303-973-8482
Mailing Address - Street 1:3405 S YARROW ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80227-4965
Mailing Address - Country:US
Mailing Address - Phone:303-973-8482
Mailing Address - Fax:303-973-8468
Practice Address - Street 1:3405 S YARROW ST
Practice Address - Street 2:SUITE C
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80227-4965
Practice Address - Country:US
Practice Address - Phone:303-973-8482
Practice Address - Fax:303-973-8468
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier