Provider Demographics
NPI:1225274145
Name:MATTHEW I. EHRLICH, M.D., P.C.
Entity Type:Organization
Organization Name:MATTHEW I. EHRLICH, M.D., P.C.
Other - Org Name:EHRLICH LASER EYE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:IAN
Authorized Official - Last Name:EHRLICH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:720-652-0224
Mailing Address - Street 1:4263 PORTOFINO DRIVE
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80503
Mailing Address - Country:US
Mailing Address - Phone:720-652-0224
Mailing Address - Fax:
Practice Address - Street 1:444 SAINT MICHAELS DR
Practice Address - Street 2:BUILDING A
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-7620
Practice Address - Country:US
Practice Address - Phone:505-954-4442
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-23
Last Update Date:2008-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2008-0788174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty