Provider Demographics
NPI:1710160726
Name:SHAW, ROBERT JAMES (LDO, CPOT)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:JAMES
Last Name:SHAW
Suffix:
Gender:M
Credentials:LDO, CPOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13504 NE 84TH ST # 103255
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98682-3091
Mailing Address - Country:US
Mailing Address - Phone:509-969-3308
Mailing Address - Fax:
Practice Address - Street 1:13504 NE 84TH ST # 103255
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98682-3091
Practice Address - Country:US
Practice Address - Phone:509-969-3308
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-12
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADO00002080156FX1800X
156FX1202X, 156FC0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
No156FX1202XEye and Vision Services ProvidersTechnician/TechnologistOptometric Technician
No156FC0801XEye and Vision Services ProvidersTechnician/TechnologistContact Lens Fitter