Provider Demographics
NPI:1659426187
Name:A & D SHOES INC
Entity Type:Organization
Organization Name:A & D SHOES INC
Other - Org Name:NOBILE SHOES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:NOBILE
Authorized Official - Suffix:
Authorized Official - Credentials:CPED LPED
Authorized Official - Phone:772-220-0845
Mailing Address - Street 1:888 COLORADO AVENUE
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994
Mailing Address - Country:US
Mailing Address - Phone:772-220-0845
Mailing Address - Fax:772-220-0304
Practice Address - Street 1:888 COLORADO AVENUE
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994
Practice Address - Country:US
Practice Address - Phone:772-220-0845
Practice Address - Fax:772-220-0304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPED45225000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic FitterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLM2185OtherBCBS FL
FL0825860001Medicare NSC