Provider Demographics
NPI:1013910967
Name:ORTHOCARE ORTHOTICS AND PORSTHETICS, INC.
Entity type:Organization
Organization Name:ORTHOCARE ORTHOTICS AND PORSTHETICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, CERTIFIED ORTHOTIST
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:O'DONELL
Authorized Official - Suffix:
Authorized Official - Credentials:CO,LO
Authorized Official - Phone:352-787-0065
Mailing Address - Street 1:PO BOX 491558
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34749-1558
Mailing Address - Country:US
Mailing Address - Phone:352-787-0065
Mailing Address - Fax:352-787-3663
Practice Address - Street 1:711 N 3RD ST
Practice Address - Street 2:STE 3
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-4495
Practice Address - Country:US
Practice Address - Phone:352-787-0065
Practice Address - Fax:352-787-3663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL4174700001Medicare ID - Type Unspecified