Healthcare Provider Details

I. General information

NPI: 1184075608
Provider Name (Legal Business Name): MATTHEW LAURENCE DECKER O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2016
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

142 E CHICAGO RD
COLDWATER MI
49036-8449
US

IV. Provider business mailing address

142 E CHICAGO RD
COLDWATER MI
49036-8449
US

V. Phone/Fax

Practice location:
  • Phone: 517-279-7927
  • Fax: 517-278-3393
Mailing address:
  • Phone: 517-279-7927
  • Fax: 517-278-3393

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4901004997
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: