Organization
CENTRAL BRACE COMPANY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GERALD WESTON BENEDICT B.O.C.O., C. PED. (OWNER/PRESIDENT)
(573) 874-0321
Entity
Organization
Contact information
Practice address
404 PORTLAND ST, REAR ENTRANCE EYE RESEARCH FOUNDATION, COLUMBIA, MO 65201-6506
(573) 874-0321
(573) 874-2003
Mailing address
404 PORTLAND ST, REAR ENTRANCE EYE RESEARCH FOUNDATION, COLUMBIA, MO 65201-6506
(573) 874-0321
(573) 874-2003
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
628004400
—
MO
Enumeration date
07/30/2006
Last updated
09/10/2009
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