MEDICARE: MATTHEW RYAN CHIAPA OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	986	NV

General Provider Information

NPI Number	:	1255818225
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW RYAN CHIAPA OD

Provider Business Mailing Address
First Line	:	3604 POE LN
Second Line	:
City	:	BAKERSFIELD
State	:	CA
Zip	:	93311-1431
Country	:	US
Telephone Number	:	661-565-1100
Fax Number	:

Provider Business Practice Location Address
First Line	:	2055 E WINDMILL LN STE 105
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89123-2070
Country	:	US
Telephone Number	:	702-731-2233
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/23/2018
Last Update Date	:	07/23/2018

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