MEDICARE: MR. MATTHEW ARMSTRONG POWERS MD, MBA

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	207WX0107X	Retina Specialist (Ophthalmology) Physician	DR.0060710	CO
2	390200000X	Student in an Organized Health Care Education/Training Program
3	207WX0107X	Retina Specialist (Ophthalmology) Physician	A139016	CA

General Provider Information

NPI Number	:	1295152379
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MATTHEW ARMSTRONG POWERS MD, MBA

Provider Business Mailing Address
First Line	:	3536 MENDOCINO AVE STE 380
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95403-3612
Country	:	US
Telephone Number	:	707-575-5353
Fax Number	:	707-578-0522

Provider Business Practice Location Address
First Line	:	3536 MENDOCINO AVE
Second Line	:	STE 380
City	:	SANTA ROSA
State	:	CA
Zip	:	95403-3612
Country	:	US
Telephone Number	:	720-848-0000
Fax Number	:

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

Provider Enumeration Date	:	03/26/2014
Last Update Date	:	07/08/2020

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