Provider Demographics
NPI:1962665802
Name:SMART PROSTHETICS ORTHOTICS INC
Entity Type:Organization
Organization Name:SMART PROSTHETICS ORTHOTICS INC
Other - Org Name:VALLEY ORTHOPEDIC TECHNOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:SETH
Authorized Official - Last Name:POTOK
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:323-662-1100
Mailing Address - Street 1:PO BOX 29568
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90029-0568
Mailing Address - Country:US
Mailing Address - Phone:323-662-1100
Mailing Address - Fax:
Practice Address - Street 1:1407 N VERMONT AVE
Practice Address - Street 2:SUITE B
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-6023
Practice Address - Country:US
Practice Address - Phone:323-662-1100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-09
Last Update Date:2011-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6154580001Medicare NSC