Organization
ISLAND PROSTHETICS & ORTHOTICS, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAVID E. MATHEWS LCP (OWNER)
(360) 678-4700
Entity
Organization
Contact information
Practice address
80 N. MAIN ST, SUITE C, COUPEVILLE, WA 98239
(360) 678-4700
(360) 678-4711
Mailing address
6921 HIGH POINT DR, CLINTON, WA 98236-8702
(360) 678-4700
(360) 678-4711
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
602433234
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0143888
LABOR & INDUSTRIES, WA
WA
01
—
5780IS
REGENCE BLUE SHIELD
WA
05
—
9052986
—
WA
Enumeration date
05/10/2006
Last updated
03/26/2012
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