Provider Demographics
NPI:1689272502
Name:MATZ, HAYDEN (OD)
Entity Type:Individual
Prefix:
First Name:HAYDEN
Middle Name:
Last Name:MATZ
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2225 SOFTWIND RD
Mailing Address - Street 2:
Mailing Address - City:NEENAH
Mailing Address - State:WI
Mailing Address - Zip Code:54956-3466
Mailing Address - Country:US
Mailing Address - Phone:920-312-3407
Mailing Address - Fax:
Practice Address - Street 1:251 N SAWYER ST
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54902-4251
Practice Address - Country:US
Practice Address - Phone:920-235-5530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-13
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3862-35152W00000X
TN3614152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist