Provider Demographics
NPI:1093824179
Name:MATSKO, THOMAS H (MD)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:H
Last Name:MATSKO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2800 11TH AVE S
Mailing Address - Street 2:SUITE 18
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59405
Mailing Address - Country:US
Mailing Address - Phone:406-761-6520
Mailing Address - Fax:406-454-1335
Practice Address - Street 1:2800 11TH AVE S
Practice Address - Street 2:SUITE 18
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405
Practice Address - Country:US
Practice Address - Phone:406-761-6520
Practice Address - Fax:406-454-1335
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MT6851207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTE72301OtherSTERLING OPT 1
MT1931OtherBCBS
MT91390Medicaid
MT91390Medicaid