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Organization
LESTERS DIABETIC SHOE SERV
Active
Organization
LESTERS DIABETIC SHOE SERV
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ETHEL B DANDY PEDORTHIC CPED (PEDORTHIC OWNER)
(803) 625-4100
Entity
Organization
Contact information
Practice address
41 BLAIR CIRCLE, ESTILL, SC 29918
(803) 625-4100
(803) 625-4100
Mailing address
PO BOX 632, 41 BLAIR CIRCLE, ESTILL, SC 29918
(803) 625-4100
(803) 625-4100
Taxonomy
Speciality
Code
Description
License number
State
211D00000X
Podiatric Assistant
Primary
—
SC
332B00000X
Durable Medical Equipment & Medical Supplies
—
SC
335E00000X
Prosthetic/Orthotic Supplier
—
SC
Other
Enumeration date
04/17/2007
Last updated
07/24/2008
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