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Land of Lakes Orthotics & Prosthetics

Prosthetic/Orthotic Supplier in Plymouth, MN · enumerated 2005 · authorized official Clark Poulson, Prosthetist Orthotist.

Data current as of Jul 13, 2026 · sourced from CMS NPPES

National Provider Identifier

1790787216

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Registry record

Entity type Organization (Type 2)
Legal business name Land of Lakes Orthotics & Prosthetics
Practice address 14395 23rd Ave N, Plymouth, MN, 55447
Fax (952) 745-3010
Enumeration date Aug 15, 2005
Last updated in NPPES May 26, 2011

Taxonomy & classification

335E00000X Prosthetic/Orthotic Supplier Suppliers Primary

Authorized official

Name Clark Poulson
Title Prosthetist Orthotist

Other identifiers

Identifier Type State Issuer
8200254 Other MN MEDICA
562317100 Medicaid MN -
121144 Other MN UCARE

What is an NPI number?

A National Provider Identifier (NPI) is a unique 10-digit number that CMS assigns to every U.S. healthcare provider and organization under HIPAA. Type 1 NPIs identify individual providers; Type 2 NPIs identify organizations. The NPI appears on insurance claims, prescriptions, and credentialing paperwork, and never changes, even if the provider moves or changes specialty.

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Frequently asked questions

What is the NPI number for Land of Lakes Orthotics & Prosthetics?
The NPI for Land of Lakes Orthotics & Prosthetics is 1790787216, a Type 2 (organization) record in the CMS NPPES registry.
Who is the authorized official for Land of Lakes Orthotics & Prosthetics?
NPPES lists Clark Poulson (Prosthetist Orthotist) as the authorized official for this organization.

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Source: CMS NPPES (public data). Snapshot 2026-07-13. Provider record last updated 2011-05-26.