Organization
MONTAGNAS SHOES INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LUCIAN F MONTAGNA JR. BOARD CERT PEDORTHIS (PRESIDENT)
(757) 490-2034
Entity
Organization
Contact information
Practice address
752 INDEPENDENCE BLVD, MONTAGNAS SHOES, VIRGINIA BEACH, VA 23455
(757) 490-2034
(757) 499-5465
Mailing address
752 INDEPENDENCE BLVD, PEMBROKE MEADOWS SHOP CENTER, VIRGINIA BEACH, VA 23455
(757) 490-2034
(757) 499-5465
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
1181
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
16367
SENTARA
—
01
—
287425
ANTHEM BCBS
—
Enumeration date
04/18/2006
Last updated
08/22/2020
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