Provider Demographics
NPI:1194881060
Name:RESTERS DIABETIC SHOES AND HOME MEDICAL
Entity type:Organization
Organization Name:RESTERS DIABETIC SHOES AND HOME MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:BRUCE
Authorized Official - Last Name:RESTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-480-1055
Mailing Address - Street 1:103 WEST COMMERCE STREET
Mailing Address - Street 2:
Mailing Address - City:ALTUS
Mailing Address - State:OK
Mailing Address - Zip Code:73521
Mailing Address - Country:US
Mailing Address - Phone:580-480-1055
Mailing Address - Fax:580-480-1077
Practice Address - Street 1:103 WEST COMMERCE STREET
Practice Address - Street 2:
Practice Address - City:ALTUS
Practice Address - State:OK
Practice Address - Zip Code:73521
Practice Address - Country:US
Practice Address - Phone:580-480-1055
Practice Address - Fax:580-480-1077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies