Provider Demographics
NPI:1467461343
Name:RICK L WOODLAND
Entity Type:Organization
Organization Name:RICK L WOODLAND
Other - Org Name:RX SHOES
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICK
Authorized Official - Middle Name:
Authorized Official - Last Name:WOODLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-617-0066
Mailing Address - Street 1:2310 HOMESTEAD RD STE I
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94024-7339
Mailing Address - Country:US
Mailing Address - Phone:408-617-0066
Mailing Address - Fax:408-617-9110
Practice Address - Street 1:2310 HOMESTEAD RD STE I
Practice Address - Street 2:
Practice Address - City:LOS ALTOS
Practice Address - State:CA
Practice Address - Zip Code:94024-7339
Practice Address - Country:US
Practice Address - Phone:408-617-0066
Practice Address - Fax:408-617-9110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-07
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========OtherTAX ID NUMBER
CA=========OtherTAX ID NUMBER