Provider Demographics
NPI:1932131521
Name:MATSUKADO, IRIS (OD)
Entity Type:Individual
Prefix:DR
First Name:IRIS
Middle Name:
Last Name:MATSUKADO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19070 BRUCE B DOWNS BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-2477
Mailing Address - Country:US
Mailing Address - Phone:813-632-2020
Mailing Address - Fax:813-631-9802
Practice Address - Street 1:19070 BRUCE B DOWNS BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33647-2477
Practice Address - Country:US
Practice Address - Phone:813-632-2020
Practice Address - Fax:813-631-9802
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC0002738152W00000X
HIOD366152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOP0482OtherEYEMED
FLU34634Medicare UPIN