MEDICARE: MARTIN M MATUS O.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
1	152W00000X	Optometrist		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01636282	OTHER	IL	BLUE CROSS / BLUE SHIELD

General Provider Information

NPI Number	:	1609872076
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARTIN M MATUS O.D.

Provider Business Mailing Address
First Line	:	1131 S ARLINGTON HEIGHTS RD
Second Line	:
City	:	ARLINGTON HTS
State	:	IL
Zip	:	60005-3140
Country	:	US
Telephone Number	:	847-290-1131
Fax Number	:	847-290-1146

Provider Business Practice Location Address
First Line	:	1131 S ARLINGTON HEIGHTS RD
Second Line	:
City	:	ARLINGTON HTS
State	:	IL
Zip	:	60005-3140
Country	:	US
Telephone Number	:	847-290-1131
Fax Number	:	847-290-1146

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

Provider Enumeration Date	:	06/21/2005
Last Update Date	:	07/08/2007

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Directions to “ MARTIN M MATUS O.D.” Practice Location

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