Provider Demographics
NPI:1578552097
Name:GADA, MATTHEW LOUIS (OD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:LOUIS
Last Name:GADA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1147 PROFESSIONAL DR STE A
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23185-3375
Mailing Address - Country:US
Mailing Address - Phone:757-259-2300
Mailing Address - Fax:757-259-2302
Practice Address - Street 1:1147 PROFESSIONAL DR STE A
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185-3375
Practice Address - Country:US
Practice Address - Phone:757-259-2300
Practice Address - Fax:757-259-2302
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-18
Last Update Date:2019-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0601002077152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA9231102Medicaid
VA9231102Medicaid
VAU59739Medicare UPIN