Provider Demographics
NPI:1962423061
Name:EASTWOOD ORTHOTICS, INC
Entity type:Organization
Organization Name:EASTWOOD ORTHOTICS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:R
Authorized Official - Last Name:BYERS
Authorized Official - Suffix:
Authorized Official - Credentials:CO
Authorized Official - Phone:330-544-6777
Mailing Address - Street 1:3877 YOUNGSTOWN RD SE
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44484-2836
Mailing Address - Country:US
Mailing Address - Phone:330-544-6777
Mailing Address - Fax:330-544-9366
Practice Address - Street 1:3877 YOUNGSTOWN RD SE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44484-2836
Practice Address - Country:US
Practice Address - Phone:330-544-6777
Practice Address - Fax:330-544-9366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2016-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCO003383335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0969840Medicaid
PA0599820002Medicare NSC
OH0969840Medicaid