Provider Demographics
NPI:1497128938
Name:FEET FOR MILES
Entity Type:Organization
Organization Name:FEET FOR MILES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VEDA
Authorized Official - Middle Name:EVONNE
Authorized Official - Last Name:LEWIS-SIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM, MHA
Authorized Official - Phone:314-323-0669
Mailing Address - Street 1:475 BROOKHAVEN CT
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63368-9632
Mailing Address - Country:US
Mailing Address - Phone:314-323-0669
Mailing Address - Fax:
Practice Address - Street 1:475 BROOKHAVEN CT
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63368-9632
Practice Address - Country:US
Practice Address - Phone:314-323-0669
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-05
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO772213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty