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General NPI Number Information
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NPI Number | 1790379220
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Entity Type | Individual
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Provider Name | MATTHEW JAMES VERBRIGGHE OD
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Gender | Male
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Dates
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Enumeration Date | 02/24/2021
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Last Update Date | 05/25/2021
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Provider Practice Location Address
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Address Line | 2822 VENTURE DR
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City | MARQUETTE
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State | MI
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Zip | 49855-8631
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Country | US
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Telephone | 906-228-4401
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Fax | 906-225-0460
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Provider Business Mailing Address
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Address Line | PO BOX 137
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City | CHATHAM
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State | MI
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Zip | 49816-0137
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Country | US
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Telephone |
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Fax |
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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 | 4901005546
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License Number State | MI
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