Provider Demographics
NPI:1114141488
Name:MATZKIN, MEREDITH G (MD)
Entity Type:Individual
Prefix:
First Name:MEREDITH
Middle Name:G
Last Name:MATZKIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:M.GENE
Other - Middle Name:
Other - Last Name:MATZKIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2230 LYNN RD
Mailing Address - Street 2:#102
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-1901
Mailing Address - Country:US
Mailing Address - Phone:805-495-0458
Mailing Address - Fax:805-494-9630
Practice Address - Street 1:2230 LYNN RD
Practice Address - Street 2:#102
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-1901
Practice Address - Country:US
Practice Address - Phone:805-495-0458
Practice Address - Fax:805-494-9630
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA22909207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWA22909AOtherPPIN
CAWA22909AOtherPPIN
CAA86613Medicare UPIN