MEDICARE: DR. MATTHEW LOUIS GADA 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	0601002077	VA

General Provider Information

NPI Number	:	1578552097
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MATTHEW LOUIS GADA O.D.

Provider Business Mailing Address
First Line	:	1147 PROFESSIONAL DR STE A
Second Line	:
City	:	WILLIAMSBURG
State	:	VA
Zip	:	23185-3375
Country	:	US
Telephone Number	:	757-259-2300
Fax Number	:	757-259-2302

Provider Business Practice Location Address
First Line	:	1147 PROFESSIONAL DR STE A
Second Line	:
City	:	WILLIAMSBURG
State	:	VA
Zip	:	23185-3375
Country	:	US
Telephone Number	:	757-259-2300
Fax Number	:	757-259-2302

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

Provider Enumeration Date	:	10/18/2005
Last Update Date	:	03/14/2019

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