Organization
VICTORIA ORTHOTIC AND PROSTHETIC SERVICES, INC
Active
Other names
VICTORIA BRACE CO
Organization subpart
No
Provider details
NPI number
Authorized official
WILFORD LEE YOUNG JR. (CEO,; C.O.; L.P.O.)
(361) 882-4991
Entity
Organization
Contact information
Practice address
1121 MORGAN AVE, CORPUS CHRISTI, TX 78404-3242
(361) 882-4991
(361) 882-4523
Mailing address
1121 MORGAN AVE, CORPUS CHRISTI, TX 78404-3242
(361) 882-4991
(361) 882-4523
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
101063
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
086148601
—
TX
05
—
086148602
—
TX
05
—
086148603
—
TX
01
—
530911
BLUE CROSS BLUE SHIELD TX
TX
Enumeration date
04/03/2007
Last updated
06/22/2015
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