Provider Demographics
NPI:1336242544
Name:O & P CUSTOM, LLC
Entity Type:Organization
Organization Name:O & P CUSTOM, LLC
Other - Org Name:DAVIS LIMB & BRACE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CP AND MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:DARREN
Authorized Official - Middle Name:R
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:CP 002814
Authorized Official - Phone:702-270-3200
Mailing Address - Street 1:939 S DECATUR BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89107-3918
Mailing Address - Country:US
Mailing Address - Phone:702-270-3200
Mailing Address - Fax:702-870-3203
Practice Address - Street 1:939 S DECATUR BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89107-3918
Practice Address - Country:US
Practice Address - Phone:702-270-3200
Practice Address - Fax:702-870-3203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2010-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
5364850001Medicare NSC