Provider Demographics
NPI:1154604692
Name:POLSTER, MATTHEW PHILLIP (OD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:PHILLIP
Last Name:POLSTER
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 1:301 N BROADWAY ST STE 4
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:WA
Mailing Address - Zip Code:98520-3933
Mailing Address - Country:US
Mailing Address - Phone:360-533-1880
Mailing Address - Fax:
Practice Address - Street 1:301 N BROADWAY ST STE 4
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:WA
Practice Address - Zip Code:98520-3933
Practice Address - Country:US
Practice Address - Phone:360-533-1880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-21
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61071257152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist