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General NPI Number Information
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NPI Number | 1174772404
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Entity Type | Organization
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Legal Business Name | COMFORT FEET, LLC
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Dates
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Enumeration Date | 09/10/2008
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Last Update Date | 01/12/2009
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Provider Practice Location Address
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Address Line | 2486 ENTERPRISE DR
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City | OPELIKA
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State | AL
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Zip | 36801-1516
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Country | US
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Telephone | 334-749-1213
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Fax | 334-749-1699
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Provider Business Mailing Address
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Address Line | 2486 ENTERPRISE DR
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City | OPELIKA
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State | AL
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Zip | 36801-1516
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Country | US
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Telephone | 334-749-1213
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Fax | 334-749-1699
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | BRETT SHELDON STARK
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Credential | DPM
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Telephone | 334-749-1213
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 1585
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License Number State | AL
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