Provider Demographics
NPI:1043202872
Name:ELGART, MATTHEW E (OD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:E
Last Name:ELGART
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1156 BOSTON POST RD
Mailing Address - Street 2:
Mailing Address - City:OLD SAYBROOK
Mailing Address - State:CT
Mailing Address - Zip Code:06475-4405
Mailing Address - Country:US
Mailing Address - Phone:860-388-2020
Mailing Address - Fax:860-388-0889
Practice Address - Street 1:1156 BOSTON POST RD
Practice Address - Street 2:
Practice Address - City:OLD SAYBROOK
Practice Address - State:CT
Practice Address - Zip Code:06475-4405
Practice Address - Country:US
Practice Address - Phone:860-388-2020
Practice Address - Fax:860-388-0889
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2009-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT680152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004023552Medicaid
CT410000439Medicare ID - Type Unspecified
CT004023552Medicaid
U01321Medicare UPIN