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General NPI Number Information
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NPI Number | 1609996453
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Entity Type | Organization
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Legal Business Name | KARA VEL SHOE STORE INC
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Dates
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Enumeration Date | 03/29/2007
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Last Update Date | 07/18/2011
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Provider Practice Location Address
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Address Line | 5525 BURNET RD SUITE 1
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City | AUSTIN
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State | TX
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Zip | 78756-1603
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Country | US
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Telephone | 512-459-7603
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Fax | 512-459-5243
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Provider Business Mailing Address
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Address Line | 5525 BURNET RD SUITE 1
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City | AUSTIN
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State | TX
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Zip | 78756-1603
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Country | US
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Telephone | 512-459-7603
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Fax | 512-459-5243
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Authorized Official
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Title or Position | OWNER
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Name | RICK RAVEL
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Credential | CERTIFIED PEDORTHIST
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Telephone | 512-459-7603
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number | 332BC3200X
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License Number State | TX
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