Provider Demographics
NPI:1386640456
Name:UYEMURA, MATTHEW J (MD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:J
Last Name:UYEMURA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1616 15TH ST
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80631-4571
Mailing Address - Country:US
Mailing Address - Phone:970-352-6688
Mailing Address - Fax:970-353-2892
Practice Address - Street 1:1616 15TH ST
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80631-4571
Practice Address - Country:US
Practice Address - Phone:970-352-6688
Practice Address - Fax:970-353-2892
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-23
Last Update Date:2013-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO38125207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO20107277Medicaid
CO20107277Medicaid
COH01128Medicare UPIN