Provider Demographics
NPI:1841428489
Name:BRESLOW, MATTHEW ELLIOT (OD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:ELLIOT
Last Name:BRESLOW
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1475 UPPER VALLEY PIKE
Mailing Address - Street 2:SUITE 448
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45504-4047
Mailing Address - Country:US
Mailing Address - Phone:614-371-4330
Mailing Address - Fax:937-525-9633
Practice Address - Street 1:1475 UPPER VALLEY PIKE
Practice Address - Street 2:SUITE 448
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45504-4047
Practice Address - Country:US
Practice Address - Phone:937-525-9266
Practice Address - Fax:937-525-9633
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-22
Last Update Date:2009-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5848152W00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program