Provider Demographics
NPI:1962792630
Name:DOERR, MATTHEW DALE (MD)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:DALE
Last Name:DOERR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:8720 STONY POINT PKWY
Mailing Address - Street 2:SUITE 135
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23235-1988
Mailing Address - Country:US
Mailing Address - Phone:804-272-8040
Mailing Address - Fax:804-272-7344
Practice Address - Street 1:8720 STONY POINT PKWY
Practice Address - Street 2:SUITE 135
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23235-1988
Practice Address - Country:US
Practice Address - Phone:804-272-8040
Practice Address - Fax:804-272-7344
Is Sole Proprietor?:No
Enumeration Date:2011-04-14
Last Update Date:2019-07-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101252608207W00000X, 207WX0110X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0110XAllopathic & Osteopathic PhysiciansOphthalmologyPediatric Ophthalmology and Strabismus Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1962792630Medicaid