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General NPI Number Information
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NPI Number | 1831353200
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Entity Type | Organization
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Legal Business Name | PACIFIC FOOTWEAR COMPANY, INC.
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Dates
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Enumeration Date | 07/15/2008
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Last Update Date | 04/22/2025
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Provider Practice Location Address
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Address Line | 2150 N 107TH ST SUITE 204
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City | SEATTLE
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State | WA
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Zip | 98133-1305
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Country | US
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Telephone | 206-957-7772
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Fax | 206-957-6021
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Provider Business Mailing Address
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Address Line | 10240 SW NIMBUS AVE SUITE L1
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City | PORTLAND
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State | OR
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Zip | 97223-4358
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Country | US
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Telephone | 503-524-9656
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Fax | 503-524-8397
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Authorized Official
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Title or Position | PRESIDENT
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Name | KEVIN W CLARKE
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Credential |
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Telephone | 206-957-7772
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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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Taxonomy #2
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number |
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License Number State |
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