Provider Demographics
NPI:1205680238
Name:LUMEN ORTHOTICS & PROSTHETICS
Entity type:Organization
Organization Name:LUMEN ORTHOTICS & PROSTHETICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED ORTHOTIST
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:T
Authorized Official - Last Name:GEORGE
Authorized Official - Suffix:
Authorized Official - Credentials:CO
Authorized Official - Phone:260-450-4999
Mailing Address - Street 1:8902 STOCKBRIDGE PL
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-3454
Mailing Address - Country:US
Mailing Address - Phone:460-450-4999
Mailing Address - Fax:
Practice Address - Street 1:8902 STOCKBRIDGE PL
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-3454
Practice Address - Country:US
Practice Address - Phone:460-450-4999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-16
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment