MEDICARE: DR. MATTHEW R DURKIN O.D.

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	TUV006167-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417951872
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MATTHEW R DURKIN O.D.

Provider Business Mailing Address
First Line	:	8395 OSWEGO RD
Second Line	:	MALARA EYECARE AND EYEWEAR GALLERY
City	:	BALDWINSVILLE
State	:	NY
Zip	:	13027-6801
Country	:	US
Telephone Number	:	315-622-3500
Fax Number	:	315-622-3522

Provider Business Practice Location Address
First Line	:	8395 OSWEGO RD
Second Line	:	MALARA EYECARE AND EYEWEAR GALLERY
City	:	BALDWINSVILLE
State	:	NY
Zip	:	13027-6801
Country	:	US
Telephone Number	:	315-622-3500
Fax Number	:	315-622-3522

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

Provider Enumeration Date	:	06/13/2005
Last Update Date	:	11/20/2012

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