# DIABETIC SHOE SOURCE INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1881056836
- **Authorized official:** ANTHONY H RIVERA C. PED (PRESIDENT)
- **Authorized official phone:** (407) 323-5093

## Contact information

- **Practice address:** 156 S CHARLES RICHARD BEALL BLVD, SUITE 3, DEBARY, FL 32713-3273
- **Practice address phone:** (407) 323-5093
- **Practice address fax:** (407) 386-8074
- **Mailing address:** 156 S CHARLES RICHARD BEALL BLVD, SUITE 3, DEBARY, FL 32713-3273
- **Mailing address phone:** (407) 323-5093
- **Mailing address fax:** (407) 386-8074

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | NOT REQUIRED | FL | Yes |

## Other

- **Enumeration date:** 03/28/2016
- **Last updated:** 03/28/2016