MEDICARE: BOND SHOE & FOOT LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	831762	OTHER	MA	TUFTS HEALTH PLAN
2	453054	OTHER	MA	BCBS
3	AA105197	OTHER	MA	HPHC

General Provider Information

NPI Number	:	1508994120
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BOND SHOE & FOOT LLC

Provider Business Mailing Address
First Line	:	100 MAPLE ST
Second Line	:
City	:	STONEHAM
State	:	MA
Zip	:	02180-3143
Country	:	US
Telephone Number	:	781-933-0602
Fax Number	:	781-497-2926

Provider Business Practice Location Address
First Line	:	100 MAPLE ST
Second Line	:
City	:	STONEHAM
State	:	MA
Zip	:	02180-3143
Country	:	US
Telephone Number	:	781-933-0602
Fax Number	:	781-497-2926

Authorized Official
Title or Position	:	GENERAL MANAGER
Name	:	MR. PETER P. BOZOVIC
Credential	:	PEDORTHIST
Telephone Number	:	781-933-0602

Provider Enumeration Date	:	03/02/2007
Last Update Date	:	01/28/2008

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Directions to “BOND SHOE & FOOT LLC ” Practice Location

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