Provider Demographics
NPI:1790719227
Name:MATTERN, RUTH M (MD)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:M
Last Name:MATTERN
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Gender:F
Credentials:MD
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Mailing Address - Street 1:1176 MAIN ST
Mailing Address - Street 2:ROSS EYE INSTITUTE
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14209-2102
Mailing Address - Country:US
Mailing Address - Phone:716-881-7900
Mailing Address - Fax:716-881-4349
Practice Address - Street 1:1176 MAIN ST
Practice Address - Street 2:ROSS EYE INSTITUTE
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14209-2102
Practice Address - Country:US
Practice Address - Phone:716-881-7900
Practice Address - Fax:716-881-4349
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2012-06-01
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Provider Licenses
StateLicense IDTaxonomies
NY182871207W00000X
AZ32988207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ418378Medicaid
8EZ96MMedicare ID - Type Unspecified
F50541Medicare UPIN