NPI 1841319415

Jack Booden, CPO

Practitioner Prosthetist Norfolk, VA

Practice location

Address: 2418 Granby St, Norfolk, VA 23517-1422
Phone: (757) 627-4191
Fax: (757) 627-8709

Registered specialties (2)

Prosthetist Primary

Respiratory, Developmental, Rehabilitative and Restorative Service Providers Taxonomy 224P00000X Licence CPO 00503

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Orthotist

Respiratory, Developmental, Rehabilitative and Restorative Service Providers Taxonomy 222Z00000X Licence CPO 00503

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Registry record

NPI: 1841319415
Entity type: Individual
Sex (as registered): Male
NPI issued: 28 Mar 2007
Record last updated: 11 Sep 2025

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.