Diabetic Shoe Source

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Legal business name

DIABETIC SHOE SOURCE

Practice address

2121 Cliff Dr Ste 118
Eagan, MN 55122-3431

Phone

(763) 757-8086

Fax

(763) 862-4797

NPI assigned

Jan 23, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Amy Luzaich, CFTS

Title

President

Phone

(763) 757-8086

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1169510400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1634774400000",
    "number": "1003960147",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2121 CLIFF DR STE 118",
            "city": "EAGAN",
            "state": "MN",
            "postal_code": "551223431",
            "telephone_number": "763-757-8086",
            "fax_number": "763-862-4797"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2121 CLIFF DR STE 118",
            "city": "EAGAN",
            "state": "MN",
            "postal_code": "551223431",
            "telephone_number": "763-757-8086",
            "fax_number": "763-862-4797"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIABETIC SHOE SOURCE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-23",
        "last_updated": "2021-10-21",
        "certification_date": "2021-10-21",
        "status": "A",
        "authorized_official_last_name": "LUZAICH",
        "authorized_official_first_name": "AMY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "763-757-8086",
        "authorized_official_credential": "CFTS"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "786A6DI",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "520052200",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Dermatology Center for Children & Young Adults PA
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• Karin Desrocher, D.C.
• Sandra Kaye Deutsch
• Missy Sue Dever, FNP-BC
• Tayler Rae Dingmann, DDS
• David Dipasquale, LAMFT
• Direct Recovery Support
• Directlink
• Bailey Christine Dirth, PSYD

• Durable Medical Equipment & Medical Supplies in Eagan, MN
• Providers in Eagan, MN by specialty
• Durable Medical Equipment & Medical Supplies in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.