Organization
DRS. FOOT SOURCE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. VICTOR S. SODERSTROM D.P.M. (OWNER)
(920) 262-8822
Entity
Organization
Contact information
Practice address
101 OAKRIDGE CT, SUITE B, WATERTOWN, WI 53094-4100
(920) 262-8822
(920) 262-6337
Mailing address
101 OAKRIDGE CT, SUITE B, WATERTOWN, WI 53094-4100
(920) 262-8822
(920) 262-6337
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
41736500
—
WI
Enumeration date
10/18/2006
Last updated
11/25/2009
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