MEDICARE: DR. MATT W. CONNER 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	152WC0802X	Corneal and Contact Management Optometrist	WA 3338	WA

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	:	1477555704
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MATT W. CONNER O.D.

Provider Business Mailing Address
First Line	:	6201 SUMMITVIEW AVE
Second Line	:	STE 101
City	:	YAKIMA
State	:	WA
Zip	:	98908-3019
Country	:	US
Telephone Number	:	509-454-8850
Fax Number	:	509-452-3293

Provider Business Practice Location Address
First Line	:	6201 SUMMITVIEW AVE
Second Line	:	STE 101
City	:	YAKIMA
State	:	WA
Zip	:	98908-3019
Country	:	US
Telephone Number	:	509-454-8850
Fax Number	:	509-452-3293

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

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	02/08/2019

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