Provider Demographics
NPI:1215995832
Name:GALBRAITH, SHAWN TAYLOR (OD)
Entity type:Individual
Prefix:MR
First Name:SHAWN
Middle Name:TAYLOR
Last Name:GALBRAITH
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 WINZENWEG
Mailing Address - Street 2:
Mailing Address - City:KOLLWEILER
Mailing Address - State:GERMANY
Mailing Address - Zip Code:66879
Mailing Address - Country:DE
Mailing Address - Phone:208-356-3926
Mailing Address - Fax:
Practice Address - Street 1:LRMC CMR 402 BOX 1778
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09180
Practice Address - Country:DE
Practice Address - Phone:0637-186-6504
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDODP-100035152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist