Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 156FC0801X | Contact Lens Fitter | ||
N | 156FX1202X | Optometric Technician | ||
Y | 156FX1800X | Optician | DO00002080 | WA |
NPI | 1710160726 |
---|---|
Provider Name | Mr. Robert James Shaw |
First Address | Vancouver, WA 98682-3091 |
Second Address | Vancouver, WA 98682-3091 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/12/2007 |
Last Update Date | 19/04/2017 |