Individual
MR. IAN MICHAEL SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CPO
Contact information
Practice address
1516 HUDSON ST STE 105, LONGVIEW, WA 98632-3046
(360) 423-6049
Mailing address
1441 NE 136TH AVE APT 284, VANCOUVER, WA 98684-5985
(360) 907-3341
Taxonomy
Speciality
Code
Description
License number
State
222Z00000X
Orthotist
CPO05333
—
224P00000X
Prosthetist
Primary
CPO05333
—
Other
Enumeration date
10/19/2023
Last updated
10/19/2023
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