Provider Demographics
NPI:1578644548
Name:MATUSIK, MICHELE A (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:A
Last Name:MATUSIK
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1017 W OAK RIDGE RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32809-4723
Mailing Address - Country:US
Mailing Address - Phone:407-859-1071
Mailing Address - Fax:407-859-1075
Practice Address - Street 1:1017 W OAK RIDGE RD
Practice Address - Street 2:SUITE A
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32809-4723
Practice Address - Country:US
Practice Address - Phone:407-859-1071
Practice Address - Fax:407-859-1075
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2009-01-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLOPC3142152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist