Provider Demographics
NPI:1225131196
Name:EMERY, MATTHEW JOHN (OD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:JOHN
Last Name:EMERY
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 1:10772 W CARSON CITY RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48838-9141
Mailing Address - Country:US
Mailing Address - Phone:616-754-5427
Mailing Address - Fax:616-754-5428
Practice Address - Street 1:10772 W CARSON CITY RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MI
Practice Address - Zip Code:48838-9141
Practice Address - Country:US
Practice Address - Phone:616-754-5427
Practice Address - Fax:616-754-5428
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901004005152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP38570001Medicare ID - Type Unspecified
MIU86554Medicare UPIN