Organization
CENTRAL ORTHOTICS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JON RICHARD TAPIO BOCO (ORTHOTIST/OWNER)
(906) 376-8000
Entity
Organization
Contact information
Practice address
431 FRONT ST, REPUBLIC, MI 49879-9100
(906) 376-8000
(616) 884-8119
Mailing address
431 FRONT ST, REPUBLIC, MI 49879-9100
(906) 376-8000
(616) 884-8119
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
5306004871
MI
335E00000X
Prosthetic/Orthotic Supplier
BOCS60682
—
335E00000X
Prosthetic/Orthotic Supplier
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1336683358
NPI
—
Enumeration date
02/15/2018
Last updated
06/16/2018
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