MEDICARE: DR. MATTHEW S WILL 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	18003274A	IN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	967880	OTHER	IN	MEDICARE PTAN

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
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1710982475
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MATTHEW S WILL O.D.

Provider Business Mailing Address
First Line	:	781 E NORTH STREET
Second Line	:
City	:	KENDALLVILLE
State	:	IN
Zip	:	46755-1225
Country	:	US
Telephone Number	:	260-347-3458
Fax Number	:	260-347-4425

Provider Business Practice Location Address
First Line	:	781 E NORTH STREET
Second Line	:
City	:	KENDALLVILLE
State	:	IN
Zip	:	46755-1225
Country	:	US
Telephone Number	:	260-347-3458
Fax Number	:	260-347-4425

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

Provider Enumeration Date	:	06/17/2005
Last Update Date	:	07/20/2016

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Directions to “ DR. MATTHEW S WILL O.D.” Practice Location

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