Provider Demographics
NPI:1104063502
Name:ACHILLES PROSTHETICS AND ORTHOTICS, INC
Entity type:Organization
Organization Name:ACHILLES PROSTHETICS AND ORTHOTICS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:NEWTON
Authorized Official - Suffix:
Authorized Official - Credentials:BS, FAC, CP
Authorized Official - Phone:661-323-5944
Mailing Address - Street 1:842 CALIFORNIA BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-2902
Mailing Address - Country:US
Mailing Address - Phone:805-541-3800
Mailing Address - Fax:805-541-3818
Practice Address - Street 1:842 CALIFORNIA BLVD
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-2902
Practice Address - Country:US
Practice Address - Phone:805-541-3800
Practice Address - Fax:805-541-3818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-07
Last Update Date:2015-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1104063502OtherCALIFORNIA CHILDREN SERVICES
CA1104063502OtherBLUE CROSS
CA1104063502Medicaid
CA199156400OtherU.S. DEPARTMENT OF LABOR
MI1104063502OtherBLUE CROSS OF MICHIGAN
CAZZZ57280YOtherBLUE SHIELD OF CALIFORNIA
TX1104063502OtherBLUE SHIELD OF TEXAS
MI1104063502OtherBLUE SHIELD OF MICHIGAN
CA=========COtherHEALTH NET
CA199156400OtherU.S. DEPARTMENT OF LABOR
CAZZZ57280YOtherBLUE SHIELD OF CALIFORNIA