Provider Demographics
NPI:1063603322
Name:OLTMANNS, MATTHEW HENRY (MD)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:HENRY
Last Name:OLTMANNS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 HIGHLAND AVE S STE 350
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205-4009
Mailing Address - Country:US
Mailing Address - Phone:205-933-2625
Mailing Address - Fax:205-558-2567
Practice Address - Street 1:2208 UNIVERSITY BLVD STE 101
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233-2313
Practice Address - Country:US
Practice Address - Phone:205-933-2625
Practice Address - Fax:205-558-2553
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-01
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL30080207W00000X, 207WX0107X, 207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL119132Medicaid
AL119132Medicaid