Provider Demographics
NPI:1487969002
Name:TAYLOR, MATTHEW (OD)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:TAYLOR
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 1:928 VALLEY VIEW DR
Mailing Address - Street 2:STE 17
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51503-5288
Mailing Address - Country:US
Mailing Address - Phone:712-256-8898
Mailing Address - Fax:
Practice Address - Street 1:928 VALLEY VIEW DR
Practice Address - Street 2:STE 17
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-5288
Practice Address - Country:US
Practice Address - Phone:712-256-8898
Practice Address - Fax:712-256-0419
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-09
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA2508152W00000X, 152W00000X
NE1357152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist