Individual
JACK BOODEN JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
C.P.O.
Contact information
Practice address
2418 GRANBY ST, NORFOLK, VA 23517-1422
(757) 627-4191
(757) 627-8709
Mailing address
2418 GRANBY ST, NORFOLK, VA 23517-1422
(757) 627-4191
(757) 627-8709
Taxonomy
Speciality
Code
Description
License number
State
222Z00000X
Orthotist
CPO 00503
—
224P00000X
Prosthetist
Primary
CPO 00503
—
Other
Enumeration date
03/28/2007
Last updated
09/11/2025
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