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General NPI Number Information
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NPI Number | 1013167253
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Entity Type | Organization
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Legal Business Name | LEBO'S SHOE STORE, INC
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Dates
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Enumeration Date | 09/24/2008
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Last Update Date | 09/24/2008
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Provider Practice Location Address
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Address Line | 7300 E INDEPENDENCE BLVD
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City | CHARLOTTE
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State | NC
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Zip | 28227-9400
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Country | US
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Telephone | 704-535-5000
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Fax |
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Provider Business Mailing Address
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Address Line | 2321 CROWN CENTRE DR
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City | CHARLOTTE
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State | NC
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Zip | 28227-7705
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Country | US
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Telephone | 704-321-5000
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Fax |
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Authorized Official
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Title or Position | FOOT SPECIALIST
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Name | BRIAN GOLDSMITH
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Credential |
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Telephone | 704-641-4243
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State |
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