Provider Demographics
NPI:1073807475
Name:RALPH'S SHOES
Entity Type:Organization
Organization Name:RALPH'S SHOES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BOB
Authorized Official - Middle Name:
Authorized Official - Last Name:MC ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:C-PED
Authorized Official - Phone:715-834-4568
Mailing Address - Street 1:336 WATER ST
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54703-6132
Mailing Address - Country:US
Mailing Address - Phone:715-834-3248
Mailing Address - Fax:715-831-7112
Practice Address - Street 1:336 WATER ST
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54703-6132
Practice Address - Country:US
Practice Address - Phone:715-834-3248
Practice Address - Fax:715-831-7112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-02
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
C-PED2969335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier