Organization
EVERGREEN PROSTHETICS AND ORTHOTICS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TIMOTHY L O'NEILL CPO (OWNER)
(503) 704-5408
Entity
Organization
Contact information
Practice address
8614 E MILL PLAIN BLVD STE 110, VANCOUVER, WA 98664-2058
(360) 213-2088
(360) 213-0311
Mailing address
911 MAIN ST STE 100, OREGON CITY, OR 97045-1853
(503) 765-5081
(971) 316-1553
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
602608675
WA
332BC3200X
Customized Equipment (DME)
602608675
WA
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9059551
—
WA
Enumeration date
03/28/2007
Last updated
11/01/2023
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