Individual
MATTHEW SHANE EVANS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CPO
Contact information
Practice address
1705 COFFEE RD, SUITE 1, MODESTO, CA 95355-2809
(209) 544-2273
(209) 544-2274
Mailing address
1705 COFFEE RD, SUITE1, MODESTO, CA 95355-2809
(209) 544-2273
(209) 544-2274
Taxonomy
Speciality
Code
Description
License number
State
222Z00000X
Orthotist
CPO02042
CA
224L00000X
Pedorthist
CPO02042
CA
224P00000X
Prosthetist
Primary
CPO02042
CA
335E00000X
Prosthetic/Orthotic Supplier
CPO02042
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
XC0020420
—
CA
Enumeration date
12/16/2008
Last updated
05/22/2014
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