Organization
KIDDER ORTHOPEDIC LABORATORIES INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN E MESSER CPO, LPO (OWNER)
(352) 795-5556
Entity
Organization
Contact information
Practice address
5676 W GULF TO LAKE HWY, CRYSTAL RIVER, FL 34429-7555
(352) 795-5556
(352) 795-5218
Mailing address
5676 W GULF TO LAKE HWY, CRYSTAL RIVER, FL 34429-7555
(352) 795-5556
(352) 795-5218
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
POR193
FL
335E00000X
Prosthetic/Orthotic Supplier
POR20
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
950296300
—
FL
01
—
M2080
BCBS
—
Enumeration date
07/15/2005
Last updated
12/27/2010
Update your record
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