Healthcare Provider Details

I. General information

NPI: 1760132765
Provider Name (Legal Business Name): MATTHEW BILLS OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2022
Last Update Date: 03/27/2023
Certification Date: 03/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 N SWITZER CANYON DR
FLAGSTAFF AZ
86001-4826
US

IV. Provider business mailing address

4800 N 22ND ST STE 210
PHOENIX AZ
85016-4963
US

V. Phone/Fax

Practice location:
  • Phone: 928-779-0500
  • Fax: 602-508-4830
Mailing address:
  • Phone: 602-955-1000
  • Fax: 602-508-4830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3163
License Number StateOK
# 3
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT-002663
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: