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General NPI Number Information
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NPI Number | 1528057700
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Entity Type | Individual
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Provider Name | MATTHEW R CANNON O.D.
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Gender | Male
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Dates
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Enumeration Date | 10/19/2005
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Last Update Date | 10/04/2011
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Provider Practice Location Address
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Address Line | 1401 HAYWOOD RD
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City | HENDERSONVILLE
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State | NC
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Zip | 28791-2335
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Country | US
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Telephone | 828-693-5205
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Fax | 828-693-0122
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Provider Business Mailing Address
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Address Line | 1401 HAYWOOD RD
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City | HENDERSONVILLE
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State | NC
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Zip | 28791-2335
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Country | US
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Telephone | 828-693-5205
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Fax | 828-693-0122
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 1147
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License Number State | NC
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