Provider Demographics
NPI:1811095516
Name:OLD DOMINION PROSTHETICS & ORTHOTICS, INC.
Entity type:Organization
Organization Name:OLD DOMINION PROSTHETICS & ORTHOTICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:B
Authorized Official - Last Name:GARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:434-973-6209
Mailing Address - Street 1:1920 MEDICAL AVE
Mailing Address - Street 2:SUITE G
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22801-8016
Mailing Address - Country:US
Mailing Address - Phone:540-433-3831
Mailing Address - Fax:540-433-5447
Practice Address - Street 1:1920 MEDICAL AVE
Practice Address - Street 2:SUITE G
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22801-8016
Practice Address - Country:US
Practice Address - Phone:540-433-3831
Practice Address - Fax:540-433-5447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV9890034000Medicaid
VA106977OtherANTHEM
WV9890034000Medicaid
WV9890034000Medicaid