Provider Demographics
NPI:1548457088
Name:LODANOS FOOTWEAR INC
Entity type:Organization
Organization Name:LODANOS FOOTWEAR INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIABETIC SPECIALIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:JO
Authorized Official - Last Name:SCHAFER
Authorized Official - Suffix:
Authorized Official - Credentials:LSW
Authorized Official - Phone:330-493-0944
Mailing Address - Street 1:1824 W STATE ST
Mailing Address - Street 2:
Mailing Address - City:ALLIANCE
Mailing Address - State:OH
Mailing Address - Zip Code:44601-3539
Mailing Address - Country:US
Mailing Address - Phone:330-493-0944
Mailing Address - Fax:330-493-5755
Practice Address - Street 1:1824 W STATE ST
Practice Address - Street 2:
Practice Address - City:ALLIANCE
Practice Address - State:OH
Practice Address - Zip Code:44601-3539
Practice Address - Country:US
Practice Address - Phone:330-493-0944
Practice Address - Fax:330-493-5755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-28
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0818080001Medicare NSC