Provider Demographics
NPI:1063825479
Name:DENNIS C MATZKIN MD PC
Entity Type:Organization
Organization Name:DENNIS C MATZKIN MD PC
Other - Org Name:ALLIED EYE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:C
Authorized Official - Last Name:MATZKIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-855-8522
Mailing Address - Street 1:7405 SHALLOWFORD RD STE 420
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-2662
Mailing Address - Country:US
Mailing Address - Phone:423-855-8522
Mailing Address - Fax:423-855-8533
Practice Address - Street 1:7405 SHALLOWFORD RD STE 420
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-2662
Practice Address - Country:US
Practice Address - Phone:423-855-8522
Practice Address - Fax:423-855-8533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-04
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN49461207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
F21332Medicare UPIN