Provider Demographics
NPI:1235298159
Name:FOOT SOLUTIONS
Entity Type:Organization
Organization Name:FOOT SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALLYN
Authorized Official - Middle Name:KIP
Authorized Official - Last Name:ODERMATT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-337-0076
Mailing Address - Street 1:5759 PACIFIC AVE
Mailing Address - Street 2:SUITE B120
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-5162
Mailing Address - Country:US
Mailing Address - Phone:209-337-0076
Mailing Address - Fax:209-337-0279
Practice Address - Street 1:5759 PACIFIC AVE
Practice Address - Street 2:SUITE B120
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-5162
Practice Address - Country:US
Practice Address - Phone:209-337-0076
Practice Address - Fax:209-337-0279
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA016903001OtherKAISER VENDOR NUMBER
CA4339390001Medicare NSC