Provider Demographics
NPI:1720068000
Name:APPLIED ORTHOTICS AND PROSTHETICS
Entity type:Organization
Organization Name:APPLIED ORTHOTICS AND PROSTHETICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:408-358-9741
Mailing Address - Street 1:700 W PARR AVE
Mailing Address - Street 2:STE D
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-1442
Mailing Address - Country:US
Mailing Address - Phone:408-358-9741
Mailing Address - Fax:408-358-1281
Practice Address - Street 1:700 W PARR AVE
Practice Address - Street 2:STE D
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-1442
Practice Address - Country:US
Practice Address - Phone:408-358-9741
Practice Address - Fax:408-358-1281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-20
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1157960001Medicare PIN