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General NPI Number Information
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NPI Number | 1558452110
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Entity Type | Organization
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Legal Business Name | STACY'S DIABETIC SHOE SERVICE, L.L.P
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Dates
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Enumeration Date | 09/27/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 7305 STONE HEARTH DR
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City | FRISCO
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State | TX
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Zip | 75035-2952
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Country | US
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Telephone | 214-705-7210
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Fax |
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Provider Business Mailing Address
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Address Line | 7305 STONE HEARTH DR
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City | FRISCO
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State | TX
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Zip | 75035-2952
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Country | US
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Telephone | 972-377-4351
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Fax |
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Authorized Official
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Title or Position | CERTIFIED PEDORTHIST
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Name | MS. STACY DONNIA CHRISTMAN
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Credential | C.PEDORTHIST
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Telephone | 972-705-7210
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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 | 3090
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License Number State | TX
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