Provider Demographics
NPI:1467534743
Name:MATTHEW I EHRLICH MD PC
Entity Type:Organization
Organization Name:MATTHEW I EHRLICH MD PC
Other - Org Name:EHRLICH LASER EYE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:I
Authorized Official - Last Name:EHRLICH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-946-1744
Mailing Address - Street 1:4236 PORTOFINO DR
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80503-4154
Mailing Address - Country:US
Mailing Address - Phone:303-946-1744
Mailing Address - Fax:720-652-0204
Practice Address - Street 1:4236 PORTOFINO DR
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80503-4154
Practice Address - Country:US
Practice Address - Phone:303-946-1744
Practice Address - Fax:720-652-0223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2009-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO43386207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC806935Medicare PIN