Provider Demographics
NPI:1720267412
Name:COLE ORTHOTICS & PROSTHETICS CENTER INC.
Entity Type:Organization
Organization Name:COLE ORTHOTICS & PROSTHETICS CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:P
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:CO
Authorized Official - Phone:419-476-4248
Mailing Address - Street 1:723 PHILLIPS AVE BLDG F
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43612-1351
Mailing Address - Country:US
Mailing Address - Phone:419-476-4248
Mailing Address - Fax:419-476-6655
Practice Address - Street 1:3048 NAVARRE AVE
Practice Address - Street 2:
Practice Address - City:OREGON
Practice Address - State:OH
Practice Address - Zip Code:43616-3308
Practice Address - Country:US
Practice Address - Phone:419-690-8366
Practice Address - Fax:419-690-8365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-30
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1122663Medicaid
OH1122663Medicaid