Organization
EASTERN VA ORTHOTICS & PROSTHETICS, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS LISA L CROUSE (OWNER/ADMIN)
(757) 850-2835
Entity
Organization
Contact information
Practice address
13394 CHESAPEAKE PL, CARROLLTON, VA 23314-3388
(757) 850-2835
(757) 850-3409
Mailing address
PO BOX 3511, HAMPTON, VA 23663-0511
(757) 850-2835
(757) 850-3409
Taxonomy
Speciality
Code
Description
License number
State
222Z00000X
Orthotist
C12887
VA
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009190384
—
VA
01
—
073161
BLUE CROSS & BLUE SHIELD
VA
01
—
1326058058
UNITED HEALTHCARE
VA
Enumeration date
08/08/2006
Last updated
05/09/2024
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