Organization
D. DOUGLAS SHAW
Active
Other names
Orthoteknics
Organization subpart
No
Provider details
NPI number
Authorized official
MR. D. DOUGLAS SHAW C.P.O (OWNER)
(802) 864-9909
Entity
Organization
Contact information
Practice address
312 COMMERCE ST, UNIT 10, WILLISTON, VT 05495-7832
(802) 864-9909
Mailing address
312 COMMERCE ST, UNIT 10, WILLISTON, VT 05495-7832
(802) 864-9909
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0009187
—
VT
05
—
01060791
—
NY
01
—
054 2771
BLUE CROSS BLUE SHIELD
VT
Enumeration date
04/07/2008
Last updated
10/03/2008
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