MEDICARE: DR. MATTHEW E ELGART OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	680	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043202872
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MATTHEW E ELGART OD

Provider Business Mailing Address
First Line	:	1156 BOSTON POST RD
Second Line	:
City	:	OLD SAYBROOK
State	:	CT
Zip	:	06475-4405
Country	:	US
Telephone Number	:	860-388-2020
Fax Number	:	860-388-0889

Provider Business Practice Location Address
First Line	:	1156 BOSTON POST RD
Second Line	:
City	:	OLD SAYBROOK
State	:	CT
Zip	:	06475-4405
Country	:	US
Telephone Number	:	860-388-2020
Fax Number	:	860-388-0889

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/18/2005
Last Update Date	:	12/29/2009

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