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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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