Provider Demographics
NPI:1245414622
Name:BONSALLS SHOES INC
Entity Type:Organization
Organization Name:BONSALLS SHOES INC
Other - Org Name:WALK RITE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARJORIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BONSALL
Authorized Official - Suffix:
Authorized Official - Credentials:PEDORTHIST
Authorized Official - Phone:408-376-0495
Mailing Address - Street 1:4701 HAMILTON AVE STE 701
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95130-1789
Mailing Address - Country:US
Mailing Address - Phone:408-376-0495
Mailing Address - Fax:
Practice Address - Street 1:60 4TH ST
Practice Address - Street 2:
Practice Address - City:GILROY
Practice Address - State:CA
Practice Address - Zip Code:95020-5176
Practice Address - Country:US
Practice Address - Phone:408-847-7999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BONSALLS SHOE CORP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-12-21
Last Update Date:2016-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies