River Bend Shoe Center

Primary specialty

Prosthetic/Orthotic SupplierTaxonomy code 335E00000X

License

004000037355701 Issued in WI

Legal business name

RIVER BEND SHOE CENTER

Practice address

7508 W Oklahoma Ave
West Allis, WI 53219-2860

Phone

(414) 543-0400

NPI assigned

Jan 8, 2009

Organization subpart

No

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

Authorized official

Name

Eric Gawlitta

Title

Owner

Phone

(414) 543-0400

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1231372800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1231372800000",
    "number": "1689811986",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7508 W OKLAHOMA AVE",
            "city": "WEST ALLIS",
            "state": "WI",
            "postal_code": "532192860",
            "telephone_number": "414-543-0400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7508 W OKLAHOMA AVE",
            "city": "WEST ALLIS",
            "state": "WI",
            "postal_code": "532192860",
            "telephone_number": "414-543-0400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RIVER BEND SHOE CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-01-08",
        "last_updated": "2009-01-08",
        "status": "A",
        "authorized_official_last_name": "GAWLITTA",
        "authorized_official_first_name": "ERIC",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "414-543-0400"
    },
    "taxonomies": [
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": "WI",
            "license": "004000037355701",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Prosthetic/Orthotic Supplier in West Allis, WI
• Providers in West Allis, WI by specialty
• Prosthetic/Orthotic Supplier in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2009; 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.