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NPI Code Detail

MEDICARE: DR. MATTHEW JOHN NUTAITIS SR. M.D.

MEDICARE: DR. MATTHEW JOHN NUTAITIS SR. M.D.
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
1207W00000XOphthalmology Physician0101040315VA
2207W00000XOphthalmology PhysicianTL 24814SC
3207WX0009XGlaucoma Specialist (Ophthalmology) Physician24814SC

General Provider Information

NPI Number : 1548240740
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MATTHEW JOHN NUTAITIS SR. M.D.
Provider Business Mailing Address
First Line : PO BOX 751461
Second Line :
City : CHARLOTTE
State : NC
Zip : 28275-1461
Country : US
Telephone Number : 843-792-6200
Fax Number :
Provider Business Practice Location Address
First Line : 171 ASHLEY AVE
Second Line :
City : CHARLESTON
State : SC
Zip : 29425-0001
Country : US
Telephone Number : 843-792-8864
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/23/2006
Last Update Date : 10/22/2020

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