MEDICARE: BONSALL'S SHOES INC

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

General Provider Information

NPI Number	:	1649454620
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BONSALL'S SHOES INC

Provider Business Mailing Address
First Line	:	4701 HAMILTON AVE STE 701
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95130-1789
Country	:	US
Telephone Number	:	408-376-0495
Fax Number	:

Provider Business Practice Location Address
First Line	:	416 N CAPITOL AVE
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95133-1938
Country	:	US
Telephone Number	:	408-259-2098
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MRS. MARJORIE BONSALL
Credential	:	PEDORTHIST
Telephone Number	:	408-376-0495

Provider Enumeration Date	:	12/26/2007
Last Update Date	:	08/17/2011

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Directions to “BONSALL'S SHOES INC ” Practice Location

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