Organization
EAST SIDE ORTHOTICS & PROSTHETICS, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
IVAN SABEL (CEO)
(503) 257-6623
Entity
Organization
Contact information
Practice address
17316 NE HALSEY ST, PORTLAND, OR 97230-6026
(503) 257-6623
(503) 257-6624
Mailing address
17316 NE HALSEY ST, PORTLAND, OR 97230-6026
(503) 257-6623
(503) 257-6624
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
297519
—
OR
01
—
611068100
OWCP
OR
01
—
9027376
WA DEPT OF SOCIAL AND HEALTH
WA
Enumeration date
05/03/2006
Last updated
05/12/2026
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