Provider Demographics
NPI:1275761793
Name:DONNER, MATTHEW JOHN (OD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:JOHN
Last Name:DONNER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:201 10TH ST
Mailing Address - Street 2:PO BOX 903
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50010-6211
Mailing Address - Country:US
Mailing Address - Phone:515-232-3451
Mailing Address - Fax:515-233-4886
Practice Address - Street 1:201 10TH ST
Practice Address - Street 2:
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50010-6211
Practice Address - Country:US
Practice Address - Phone:515-232-3451
Practice Address - Fax:515-233-4886
Is Sole Proprietor?:No
Enumeration Date:2009-06-23
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA002456152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist