MEDICARE: DR. MATTHEW DAVID CALLEWAERT 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	60391555	WA

General Provider Information

NPI Number	:	1548692114
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MATTHEW DAVID CALLEWAERT O.D.

Provider Business Mailing Address
First Line	:	2841 N PENSTEMON ST
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67226-1811
Country	:	US
Telephone Number	:	316-207-1955
Fax Number	:

Provider Business Practice Location Address
First Line	:	134 CENTRAL WAY
Second Line	:
City	:	KIRKLAND
State	:	WA
Zip	:	98033-6106
Country	:	US
Telephone Number	:	425-889-2020
Fax Number	:

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

Provider Enumeration Date	:	08/06/2013
Last Update Date	:	08/06/2013

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