Provider Demographics
NPI:1154545945
Name:SHOE DESIGN
Entity type:Organization
Organization Name:SHOE DESIGN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED PEDORTHIST
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:MARIO
Authorized Official - Last Name:CALDERONE
Authorized Official - Suffix:
Authorized Official - Credentials:C PED
Authorized Official - Phone:970-243-4777
Mailing Address - Street 1:648 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-2708
Mailing Address - Country:US
Mailing Address - Phone:970-243-4777
Mailing Address - Fax:970-243-4777
Practice Address - Street 1:648 MAIN STREET
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-2708
Practice Address - Country:US
Practice Address - Phone:970-243-4777
Practice Address - Fax:970-243-4777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO08003972Medicaid
4394750001Medicare ID - Type Unspecified