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Organization
CUSTOM ORTHOTICS OF NORTH CAROLINA, LLC
Active
Organization
CUSTOM ORTHOTICS OF NORTH CAROLINA, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. STEPHEN BRADLEY DEAL BO, CO (OPERATIONS MANAGER, ORTHOTIST)
(919) 479-5990
Entity
Organization
Contact information
Practice address
4125 BEN FRANKLIN BLVD, SUITE 180, DURHAM, NC 27704-2167
(919) 479-5990
(919) 479-8782
Mailing address
4125 BEN FRANKLIN BLVD, SUITE 180, DURHAM, NC 27704-2167
(919) 479-5990
(919) 479-8782
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
Primary
C18399
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
046P3
BCBS PROVIDER NUMBER
NC
05
—
7704266
—
NC
Enumeration date
07/17/2006
Last updated
08/22/2020
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