Provider Demographics
NPI:1477555704
Name:CONNER, MATT W (OD)
Entity Type:Individual
Prefix:DR
First Name:MATT
Middle Name:W
Last Name:CONNER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:6201 SUMMITVIEW AVE
Mailing Address - Street 2:STE 101
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98908-3019
Mailing Address - Country:US
Mailing Address - Phone:509-454-8850
Mailing Address - Fax:509-452-3293
Practice Address - Street 1:6201 SUMMITVIEW AVE
Practice Address - Street 2:STE 101
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98908-3019
Practice Address - Country:US
Practice Address - Phone:509-454-8850
Practice Address - Fax:509-452-3293
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2019-02-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAWA 3338152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2021970Medicaid
WA2021970Medicaid
WAAB37231Medicare ID - Type Unspecified