Provider Demographics
NPI:1871063420
Name:OTTO BOCK ORTHOPEDIC SERVICES LLC
Entity type:Organization
Organization Name:OTTO BOCK ORTHOPEDIC SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EVP OF LICENSURE
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-806-2756
Mailing Address - Street 1:PO BOX 734949
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-4949
Mailing Address - Country:US
Mailing Address - Phone:800-736-8276
Mailing Address - Fax:866-642-2302
Practice Address - Street 1:1661 N RAYMOND AVE STE 140A
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-1167
Practice Address - Country:US
Practice Address - Phone:800-736-8276
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-27
Last Update Date:2025-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA101351003OtherSELLER PERMIT
CA104746OtherHME LICENSE
CA104746OtherHME LICENSE