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:
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Health care specialties

SpecialtyCodeLicense #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 11 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.

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Identifiers

StateTypeNumberIssuer
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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