Provider Demographics
NPI:1508994120
Name:BOND SHOE & FOOT LLC
Entity Type:Organization
Organization Name:BOND SHOE & FOOT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:P
Authorized Official - Last Name:BOZOVIC
Authorized Official - Suffix:
Authorized Official - Credentials:PEDORTHIST
Authorized Official - Phone:781-933-0602
Mailing Address - Street 1:100 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:STONEHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02180-3143
Mailing Address - Country:US
Mailing Address - Phone:781-933-0602
Mailing Address - Fax:781-497-2926
Practice Address - Street 1:100 MAPLE ST
Practice Address - Street 2:
Practice Address - City:STONEHAM
Practice Address - State:MA
Practice Address - Zip Code:02180-3143
Practice Address - Country:US
Practice Address - Phone:781-933-0602
Practice Address - Fax:781-497-2926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA831762OtherTUFTS HEALTH PLAN
MA453054OtherBCBS
MAAA105197OtherHPHC
MA453054OtherBCBS