Provider Demographics
NPI:1407504137
Name:OPTIMAL FEET, LLC
Entity Type:Organization
Organization Name:OPTIMAL FEET, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:H
Authorized Official - Last Name:DERENDORF
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:210-369-9300
Mailing Address - Street 1:9815 W IH 10
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-2243
Mailing Address - Country:US
Mailing Address - Phone:210-369-9300
Mailing Address - Fax:
Practice Address - Street 1:9815 W IH 10
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-2243
Practice Address - Country:US
Practice Address - Phone:210-369-9300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-11
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier