Healthcare Provider Details

I. General information

NPI: 1750450573
Provider Name (Legal Business Name): MATTHEW S OLIVA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 07/18/2023
Certification Date: 07/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1333 E BARNETT RD
MEDFORD OR
97504
US

IV. Provider business mailing address

1333 E BARNETT RD
MEDFORD OR
97504-8219
US

V. Phone/Fax

Practice location:
  • Phone: 541-779-4711
  • Fax: 541-779-0796
Mailing address:
  • Phone: 541-779-4711
  • Fax: 541-618-1485

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD00043824
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code207WX0120X
TaxonomyCornea and External Diseases Specialist Physician
License NumberMD27019
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: