Sullivan, Matthew Ryan
Sullivan, Matthew Ryan is an individual health care provider with primary practice located at 980 Willow Creek Road Suite 202, Prescott AZ 86301-1610. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Sullivan, Matthew Ryan can be contacted via phone (928) 778-3937.Contact Information
Primary practice address
980 Willow Creek Road Suite 202
Prescott AZ 86301-1610
Phone: (928) 778-3937
Fax: (928) 778-3939
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Eye and Vision Services Providers / Optometrist | 152W00000X | 1102 | Arizona |
Profile Details
| NPI number | 1053311472 |
|---|---|
| LBN Legal business name | Sullivan, Matthew Ryan |
| Credentials | Doctor of Optometry (OD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jul 28th, 2005 |
| Last updated | Jan 2nd, 2014 - about 10 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1053311472 | NPPES |
| Arizona | Other | 1053311472 | INDIVIDUAL NPI |
| Arizona | Other | 410045761 | INDIVIDUAL NPI |
| Arizona | Other | 1285813360 | INDIVIDUAL NPI |
| Arizona | Other | 64294 | INDIVIDUAL NPI |
| Arizona | Other | 1102 | INDIVIDUAL NPI |
| Arizona | MEDICAID | 620353 | INDIVIDUAL NPI |
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