Provider Demographics
NPI:1578547550
Name:MATTAS, STEVEN JOHN (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:JOHN
Last Name:MATTAS
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 1:1935 BLUEGRASS AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40215-1179
Mailing Address - Country:US
Mailing Address - Phone:502-895-0040
Mailing Address - Fax:502-361-4488
Practice Address - Street 1:1935 BLUEGRASS AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40215-1179
Practice Address - Country:US
Practice Address - Phone:502-895-0040
Practice Address - Fax:502-361-4488
Is Sole Proprietor?:No
Enumeration Date:2005-12-02
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY24542207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64245426Medicaid
IN200380430Medicaid
KY0249503Medicare ID - Type Unspecified
IN200380430Medicaid
KY64245426Medicaid
C68356Medicare UPIN
IN331420DMedicare ID - Type Unspecified