Organization
KARA VEL SHOE STORE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RICK RAVEL CERTIFIED PEDORTHIST (OWNER)
(512) 459-7603
Entity
Organization
Contact information
Practice address
5525 BURNET RD, SUITE 1, AUSTIN, TX 78756-1603
(512) 459-7603
(512) 459-5243
Mailing address
5525 BURNET RD, SUITE 1, AUSTIN, TX 78756-1603
(512) 459-7603
(512) 459-5243
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
Primary
332BC3200X
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
086609701
—
TX
01
—
504971
BCBS PROVIDER ID
TX
Enumeration date
03/29/2007
Last updated
07/18/2011
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