Provider Demographics
NPI:1447384276
Name:3 DUCKS LTD
Entity Type:Organization
Organization Name:3 DUCKS LTD
Other - Org Name:FOOT SOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:EASON
Authorized Official - Suffix:
Authorized Official - Credentials:CERTIFIED PEDORTHIST
Authorized Official - Phone:760-674-2121
Mailing Address - Street 1:72345 HIGHWAY 111
Mailing Address - Street 2:DESERT CROSSING SHOPPING CENTER
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92260-2746
Mailing Address - Country:US
Mailing Address - Phone:760-674-2121
Mailing Address - Fax:760-674-0555
Practice Address - Street 1:72345 HIGHWAY 111
Practice Address - Street 2:DESERT CROSSING SHOPPING CENTER
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260-2746
Practice Address - Country:US
Practice Address - Phone:760-674-2121
Practice Address - Fax:760-674-0555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2008-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5095130001Medicare NSC