Provider Demographics
NPI:1346618956
Name:BIEDRON, MATTHEW TIMOTHY (OD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:TIMOTHY
Last Name:BIEDRON
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 1:2282 E PINETREE BLVD
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31792-4807
Mailing Address - Country:US
Mailing Address - Phone:229-226-6000
Mailing Address - Fax:229-226-5859
Practice Address - Street 1:2282 E PINETREE BLVD
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31792-4807
Practice Address - Country:US
Practice Address - Phone:229-226-6000
Practice Address - Fax:229-226-5859
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-14
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT003067152W00000X, 152W00000X
PAOEG003115152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003213877AMedicaid
GA003213877BMedicaid