Organization
CUSTOM ORTHOTICS OF NORTH CAROLINA, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. STEPHEN BRADLEY DEAL BO, CO (OPERATIONS MANAGER, ORTHOTIST)
(919) 479-5990
Entity
Organization
Contact information
Practice address
4125 BEN FRANKLIN BLVD, SUITE 180, DURHAM, NC 27704-2167
(919) 479-5990
(919) 479-8782
Mailing address
4125 BEN FRANKLIN BLVD, SUITE 180, DURHAM, NC 27704-2167
(919) 479-5990
(919) 479-8782
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
Primary
C18399
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
046P3
BCBS PROVIDER NUMBER
NC
05
—
7704266
—
NC
Enumeration date
07/17/2006
Last updated
08/22/2020
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