Healthcare Provider Details

I. General information

NPI: 1477883577
Provider Name (Legal Business Name): MATTHEW L. HARKIN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2010
Last Update Date: 05/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2304 N WHEELING AVE
MUNCIE IN
47303-1619
US

IV. Provider business mailing address

2304 N WHEELING AVE
MUNCIE IN
47303-1619
US

V. Phone/Fax

Practice location:
  • Phone: 765-288-5301
  • Fax: 765-284-3460
Mailing address:
  • Phone: 765-288-5301
  • Fax: 765-284-3460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DR. MATTHEW L. HARKIN
Title or Position: OWNER
Credential: O.D.
Phone: 765-288-5301