Matthew Ryan Sullivan OD

NPI 1053311472 - Optometrist - 152W00000X

NPI Details
NPI 1053311472
Gender Male
Enumeration Date 07/28/2005
Last Updated 01/02/2014
Entity Type Individual
Active Over 11 years ago
Practice Location
980 WILLOW CREEK ROAD
SUITE 202
PRESCOTT AZ, 86301-1610, US
Phone (928) 778-3937
Fax (928) 778-3939
Business Location
980 WILLOW CREEK ROAD
SUITE 202
PRESCOTT AZ, 86301-1610, US
Phone (928) 778-3937
Fax (928) 778-3939
Toxanomy
Taxonomy Code 152W00000X
License State Arizona
License Number 1102
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According to our database, Dr. Matthew Ryan Sullivan OD NPI is 1053311472, taxonomy code is 152W00000X and license number is 1102, license state is located at Arizona. Matthew Ryan Sullivan OD physically located at 980 Willow Creek Road, Prescott AZ, 86301-1610. NPI Number Matthew Ryan Sullivan OD has the Individual type.

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1053311472 NPI number is provided on an as is basis without warranty of any kind. 1053311472 is maintained by the National Plan & Provider Enumeration System. The contents of Matthew Ryan Sullivan OD are for informational purposes only.