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General NPI Number Information
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NPI Number | 1821048034
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Entity Type | Organization
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Legal Business Name | ISLAND PROSTHETICS & ORTHOTICS, INC.
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Dates
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Enumeration Date | 05/10/2006
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Last Update Date | 03/26/2012
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Provider Practice Location Address
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Address Line | 80 N. MAIN ST SUITE C
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City | COUPEVILLE
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State | WA
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Zip | 98239
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Country | US
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Telephone | 360-678-4700
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Fax | 360-678-4711
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Provider Business Mailing Address
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Address Line | 6921 HIGH POINT DR
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City | CLINTON
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State | WA
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Zip | 98236-8702
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Country | US
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Telephone | 360-678-4700
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Fax | 360-678-4711
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Authorized Official
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Title or Position | OWNER
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Name | MR. DAVID E. MATHEWS
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Credential | LCP
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Telephone | 360-678-4700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number | 602433234
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License Number State | WA
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