Organization
FOOT CARE STORE, LLC
Active
Parent organization
FOOT CARE STORE, LLC
Other names
Dia-Foot
Organization subpart
Yes
Provider details
NPI number
Legal business name
FOOT CARE STORE, LLC
Authorized official
DR. ROBERT MARK GAYNOR DPM (DIRECTOR)
(156) 186-6338
Entity
Organization
Contact information
Practice address
4280 W WINDMILL LN STE 111, LAS VEGAS, NV 89139-5857
(561) 721-7063
(561) 791-9919
Mailing address
3281 FAIRLANE FARMS RD, WELLINGTON, FL 33414-6503
(615) 721-7063
(561) 791-9919
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
029761500
—
FL
Enumeration date
03/05/2021
Last updated
01/12/2026
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