Provider Demographics
NPI:1447366869
Name:ROUND ROCK ORTHOTICS & PROSTHETICS, INC.
Entity type:Organization
Organization Name:ROUND ROCK ORTHOTICS & PROSTHETICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIK
Authorized Official - Middle Name:ROY
Authorized Official - Last Name:OLSON
Authorized Official - Suffix:
Authorized Official - Credentials:LPO
Authorized Official - Phone:512-341-3700
Mailing Address - Street 1:555 ROUND ROCK WEST DR BLDG D
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-5052
Mailing Address - Country:US
Mailing Address - Phone:512-341-3700
Mailing Address - Fax:
Practice Address - Street 1:2911 MEDICAL ARTS ST
Practice Address - Street 2:BUILDING 7
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-3376
Practice Address - Country:US
Practice Address - Phone:512-341-3700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2008-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101272335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1427059203OtherNPI--ROUND ROCK LOCATION
TX101272OtherTEXAS BOARD OF ORTHOTICS AND PROSTHETICS LICENSE NUMBER
TX101272OtherTEXAS BOARD OF ORTHOTICS AND PROSTHETICS LICENSE NUMBER