Provider Demographics
NPI:1417578121
Name:SIERRA ORTHOPEDIC LABORATORY, INC.
Entity type:Organization
Organization Name:SIERRA ORTHOPEDIC LABORATORY, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:JEFFRIES
Authorized Official - Suffix:
Authorized Official - Credentials:CO
Authorized Official - Phone:707-528-9808
Mailing Address - Street 1:PO BOX 1848
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94948-1848
Mailing Address - Country:US
Mailing Address - Phone:707-528-9808
Mailing Address - Fax:707-528-9818
Practice Address - Street 1:157 LYNCH CREEK WAY
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94954-2342
Practice Address - Country:US
Practice Address - Phone:707-528-9808
Practice Address - Fax:707-528-9818
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SIERRA ORTHOPEDIC LABORATORY, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-05-04
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier