Provider Demographics
NPI:1326483058
Name:MATTHEW LITTLEJOHN OD PC
Entity Type:Organization
Organization Name:MATTHEW LITTLEJOHN OD PC
Other - Org Name:CASA GRANDE EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:LITTLEJOHN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:520-836-9606
Mailing Address - Street 1:1968 N PEART RD STE 12
Mailing Address - Street 2:
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85122-2496
Mailing Address - Country:US
Mailing Address - Phone:520-836-9606
Mailing Address - Fax:520-836-3964
Practice Address - Street 1:1968 N PEART RD STE 12
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85122-2496
Practice Address - Country:US
Practice Address - Phone:520-836-9606
Practice Address - Fax:520-836-3964
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-08
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1525152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ152W00000XOtherTAXONOMY
AZZ162081Medicare PIN
AZ152W00000XOtherTAXONOMY
AZV10381Medicare UPIN