Provider Demographics
NPI:1164414207
Name:HARKIN, MATTHEW L
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:L
Last Name:HARKIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2304 N WHEELING AVE
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47303-1619
Mailing Address - Country:US
Mailing Address - Phone:765-288-5301
Mailing Address - Fax:765-284-3460
Practice Address - Street 1:2304 N WHEELING AVE
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47303-1619
Practice Address - Country:US
Practice Address - Phone:765-288-5301
Practice Address - Fax:765-284-3460
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-16
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002584A152W00000X
IN18002584B152WL0500X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN208840Medicare PIN
INU34053Medicare UPIN
IN0242310001Medicare NSC