Provider Demographics
NPI:1750359048
Name:OPTECH ORTHOTICS & PROSTHETICS CORP
Entity type:Organization
Organization Name:OPTECH ORTHOTICS & PROSTHETICS CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED ORTHOTIST PROSTHETIST
Authorized Official - Prefix:MR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:B
Authorized Official - Last Name:MCNAB
Authorized Official - Suffix:JR
Authorized Official - Credentials:CPO
Authorized Official - Phone:815-932-8564
Mailing Address - Street 1:119 E COURT ST STE 100
Mailing Address - Street 2:
Mailing Address - City:KANKAKEE
Mailing Address - State:IL
Mailing Address - Zip Code:60901-3823
Mailing Address - Country:US
Mailing Address - Phone:815-932-8564
Mailing Address - Fax:815-932-8640
Practice Address - Street 1:119 E COURT ST STE 100
Practice Address - Street 2:
Practice Address - City:KANKAKEE
Practice Address - State:IL
Practice Address - Zip Code:60901-3823
Practice Address - Country:US
Practice Address - Phone:815-932-8564
Practice Address - Fax:815-932-8640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-10
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL04622011OtherBCBS
IL80544OtherNORTHWOOD UHC
IL80544OtherNORTHWOOD UHC
IL1245500001Medicare NSC