Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Customized Equipment |
332BC3200X | 87 | All Other Suppliers | |
Prosthetic/Orthotic Supplier |
335E00000X | 51 | Medical Supply Company with Orthotist |
| NPI # | 1558316851 |
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| LBN Legal business name | PACIFIC FOOTWEAR COMPANY, INC. | ||||||||||||
| Authorized official | KEVIN CLARKE - (PRESIDENT) | ||||||||||||
| Entity | Organization | ||||||||||||
| Organization subpart 1 | No | ||||||||||||
| Enumeration date | 05/24/2006 | ||||||||||||
| Last updated | 04/22/2025 - More than a year ago | ||||||||||||
| Identifiers |
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