Provider Demographics
NPI:1316030992
Name:ODERMATT ENTERPRISES INC
Entity Type:Organization
Organization Name:ODERMATT ENTERPRISES INC
Other - Org Name:SHOES THAT FIT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:BARBARA
Authorized Official - Last Name:ODERMATT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-337-0076
Mailing Address - Street 1:2210 PACIFIC AVE
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95204-5334
Mailing Address - Country:US
Mailing Address - Phone:209-337-0076
Mailing Address - Fax:209-463-4897
Practice Address - Street 1:8649 ELK GROVE BLVD
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95624-1790
Practice Address - Country:US
Practice Address - Phone:209-337-0076
Practice Address - Fax:209-463-4897
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0191089OtherKAISER VENDOR NUMBER
5451250002Medicare NSC