Provider Demographics
NPI:1649454620
Name:BONSALL'S SHOES INC
Entity type:Organization
Organization Name:BONSALL'S SHOES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARJORIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BONSALL
Authorized Official - Suffix:
Authorized Official - Credentials:PEDORTHIST
Authorized Official - Phone:408-376-0495
Mailing Address - Street 1:4701 HAMILTON AVE STE 701
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95130-1789
Mailing Address - Country:US
Mailing Address - Phone:408-376-0495
Mailing Address - Fax:
Practice Address - Street 1:416 N CAPITOL AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95133-1938
Practice Address - Country:US
Practice Address - Phone:408-259-2098
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BONSALL SHOE CORP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-12-26
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies