Provider Demographics
NPI:1235459256
Name:SOLE DIMENSIONS LLC
Entity Type:Organization
Organization Name:SOLE DIMENSIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELEANOR
Authorized Official - Middle Name:
Authorized Official - Last Name:PENNER
Authorized Official - Suffix:
Authorized Official - Credentials:C PED
Authorized Official - Phone:919-424-6796
Mailing Address - Street 1:302 SOUTHTOWN CIR # 14
Mailing Address - Street 2:
Mailing Address - City:ROLESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27571-9573
Mailing Address - Country:US
Mailing Address - Phone:919-424-6796
Mailing Address - Fax:800-891-5542
Practice Address - Street 1:10405 LIGON MILL RD STE B
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-5013
Practice Address - Country:US
Practice Address - Phone:919-424-6796
Practice Address - Fax:800-891-5542
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-02
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier