Provider Demographics
NPI:1417951872
Name:DURKIN, MATTHEW R (OD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:R
Last Name:DURKIN
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 1:8395 OSWEGO RD
Mailing Address - Street 2:MALARA EYECARE AND EYEWEAR GALLERY
Mailing Address - City:BALDWINSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13027-6801
Mailing Address - Country:US
Mailing Address - Phone:315-622-3500
Mailing Address - Fax:315-622-3522
Practice Address - Street 1:8395 OSWEGO RD
Practice Address - Street 2:MALARA EYECARE AND EYEWEAR GALLERY
Practice Address - City:BALDWINSVILLE
Practice Address - State:NY
Practice Address - Zip Code:13027-6801
Practice Address - Country:US
Practice Address - Phone:315-622-3500
Practice Address - Fax:315-622-3522
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV006167-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01960892Medicaid
NYBB6746Medicare ID - Type Unspecified