Provider Demographics
NPI:1912257726
Name:SOCKET FIT PROSTHETICS, LLC
Entity Type:Organization
Organization Name:SOCKET FIT PROSTHETICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:M
Authorized Official - Last Name:VANNAH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, BOCP
Authorized Official - Phone:857-250-5080
Mailing Address - Street 1:58 HENRY ST
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:MA
Mailing Address - Zip Code:01002-1250
Mailing Address - Country:US
Mailing Address - Phone:857-250-5080
Mailing Address - Fax:
Practice Address - Street 1:58 HENRY ST
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:MA
Practice Address - Zip Code:01002-1250
Practice Address - Country:US
Practice Address - Phone:857-250-5080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-19
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetistGroup - Single Specialty