Provider Demographics
NPI:1154399814
Name:INNOVATIVE ORTHOTICS AND PROSTHETICS OF LA, INC.
Entity type:Organization
Organization Name:INNOVATIVE ORTHOTICS AND PROSTHETICS OF LA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED PROSTHETIST/ORTHOTIST/
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:S
Authorized Official - Last Name:LAYMAN
Authorized Official - Suffix:
Authorized Official - Credentials:BOCPO, CPO
Authorized Official - Phone:504-464-5577
Mailing Address - Street 1:720 WILLIAMS BLVD
Mailing Address - Street 2:
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70062-7638
Mailing Address - Country:US
Mailing Address - Phone:504-464-5577
Mailing Address - Fax:504-464-5677
Practice Address - Street 1:720 WILLIAMS BLVD
Practice Address - Street 2:
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70062-7638
Practice Address - Country:US
Practice Address - Phone:504-464-5577
Practice Address - Fax:504-464-5677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1979481Medicaid
LA0599680001Medicare ID - Type UnspecifiedPROVIDER NUMBER