Healthcare Provider Details

I. General information

NPI: 1679262836
Provider Name (Legal Business Name): MATTHEW BRILLON OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2023
Last Update Date: 07/17/2023
Certification Date: 07/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 FAUNCE CORNER RD
DARTMOUTH MA
02747-1278
US

IV. Provider business mailing address

17 DOTYS MILL RD
ACUSHNET MA
02743-1230
US

V. Phone/Fax

Practice location:
  • Phone: 508-717-0270
  • Fax:
Mailing address:
  • Phone: 508-717-5902
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT5630
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: