Healthcare Provider Details

I. General information

NPI: 1558845081
Provider Name (Legal Business Name): MATTHEW FRANCIS BYERS OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2018
Last Update Date: 09/29/2022
Certification Date: 09/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 MARTIN DR
FREDONIA WI
53021-9455
US

IV. Provider business mailing address

8614 WESTWOOD CENTER DR FL 9
VIENNA VA
22182-2442
US

V. Phone/Fax

Practice location:
  • Phone: 262-692-9000
  • Fax: 262-692-2797
Mailing address:
  • Phone: 703-847-8899
  • Fax: 571-223-6780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3522-35
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: