Provider Demographics
NPI:1083636492
Name:STANLEY, MATTHEW THOMAS (OD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:THOMAS
Last Name:STANLEY
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 1:1640 CHARLES PL
Mailing Address - Street 2:STE 103
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66502-2868
Mailing Address - Country:US
Mailing Address - Phone:785-776-9461
Mailing Address - Fax:785-776-9946
Practice Address - Street 1:1640 CHARLES PL STE 103
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502-2868
Practice Address - Country:US
Practice Address - Phone:785-776-9461
Practice Address - Fax:785-776-9946
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2022-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1757152W00000X
MO2006020350152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200406160BMedicaid