Provider Demographics
NPI:1750791190
Name:PRO TEC ORTHOTICS
Entity type:Organization
Organization Name:PRO TEC ORTHOTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHOTIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:REED
Authorized Official - Last Name:BRIGANCE
Authorized Official - Suffix:
Authorized Official - Credentials:CO,LO
Authorized Official - Phone:405-570-4790
Mailing Address - Street 1:3625 W MAIN ST
Mailing Address - Street 2:SUITE 108
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73072-4656
Mailing Address - Country:US
Mailing Address - Phone:405-570-4790
Mailing Address - Fax:405-570-4790
Practice Address - Street 1:3625 W MAIN ST
Practice Address - Street 2:SUITE 108
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73072-4656
Practice Address - Country:US
Practice Address - Phone:405-570-4790
Practice Address - Fax:405-570-4790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-07
Last Update Date:2014-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKLO 10335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier