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General NPI Number Information
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NPI Number | 1770965097
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Entity Type | Organization
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Legal Business Name | EDWARD L. MATUSIK, OD PA
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Dates
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Enumeration Date | 06/23/2015
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Last Update Date | 06/23/2015
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Provider Practice Location Address
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Address Line | 1017 W OAK RIDGE RD STE A
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City | ORLANDO
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State | FL
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Zip | 32809-4723
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Country | US
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Telephone | 407-859-1071
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Fax | 407-859-1075
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Provider Business Mailing Address
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Address Line | 1017 W OAK RIDGE RD STE A
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City | ORLANDO
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State | FL
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Zip | 32809-4723
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Country | US
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Telephone | 407-859-1071
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Fax | 407-859-1075
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Authorized Official
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Title or Position | PRESIDENT
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Name | EDWARD L MATUSIK
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Credential | OD
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Telephone | 407-859-1071
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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 | OPC1238
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License Number State | FL
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