Organization
OPTIMA PROSTHETICS & ORTHOTICS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHEN KIRK WILSON CERTIFIED ORTHOTIST (CEO)
(775) 750-7429
Entity
Organization
Contact information
Practice address
780 SMITHRIDGE DR, RENO, NV 89502-5798
(775) 750-7429
(775) 499-2707
Mailing address
780 SMITHRIDGE DR, RENO, NV 89502-5798
(775) 229-2503
(775) 499-2707
Taxonomy
Speciality
Code
Description
License number
State
224P00000X
Prosthetist
Primary
—
—
335E00000X
Prosthetic/Orthotic Supplier
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NV20191397735
COMMERCIAL INSURANCE
NV
Enumeration date
05/31/2019
Last updated
01/14/2021
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