MEDICARE: FOOT SOLUTIONS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	016903001	OTHER	CA	KAISER VENDOR NUMBER

General Provider Information

NPI Number	:	1235298159
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOOT SOLUTIONS

Provider Business Mailing Address
First Line	:	5759 PACIFIC AVE
Second Line	:	SUITE B120
City	:	STOCKTON
State	:	CA
Zip	:	95207-5162
Country	:	US
Telephone Number	:	209-337-0076
Fax Number	:	209-337-0279

Provider Business Practice Location Address
First Line	:	5759 PACIFIC AVE
Second Line	:	SUITE B120
City	:	STOCKTON
State	:	CA
Zip	:	95207-5162
Country	:	US
Telephone Number	:	209-337-0076
Fax Number	:	209-337-0279

Authorized Official
Title or Position	:	OWNER
Name	:	ALLYN KIP ODERMATT
Credential	:
Telephone Number	:	209-337-0076

Provider Enumeration Date	:	12/06/2006
Last Update Date	:	08/11/2011

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Directions to “FOOT SOLUTIONS ” Practice Location

Language	Start Address	Practice Location

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