Provider Demographics
NPI:1316488307
Name:LAKES ORTHOTICS & PROSTHETICS INC
Entity type:Organization
Organization Name:LAKES ORTHOTICS & PROSTHETICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:PERRY
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:952-745-3004
Mailing Address - Street 1:14395 23RD AVE N
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55447-4704
Mailing Address - Country:US
Mailing Address - Phone:952-745-3004
Mailing Address - Fax:952-745-3010
Practice Address - Street 1:14395 23RD AVE N
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55447-4704
Practice Address - Country:US
Practice Address - Phone:952-745-3004
Practice Address - Fax:952-745-3010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-10
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier