Provider Demographics
NPI:1023674488
Name:TESTA, MATTHEW (OD)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:TESTA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 296
Mailing Address - Street 2:
Mailing Address - City:FERGUSON
Mailing Address - State:KY
Mailing Address - Zip Code:42533-0296
Mailing Address - Country:US
Mailing Address - Phone:606-492-2211
Mailing Address - Fax:606-676-0873
Practice Address - Street 1:467 SUNSET TRL
Practice Address - Street 2:
Practice Address - City:JELLICO
Practice Address - State:TN
Practice Address - Zip Code:37762-2709
Practice Address - Country:US
Practice Address - Phone:423-784-2020
Practice Address - Fax:423-784-4940
Is Sole Proprietor?:No
Enumeration Date:2019-05-11
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3562152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
6260267OtherBCBS OF TN
TNQ055012Medicaid
KYQ00166483OtherRR MEDICARE
1023674488OtherEYEMED
5764048OtherANTHEM BCBS OF KY
1023674488OtherUNITED HEALTHCARE
1023674488OtherVSP
1023674488OtherHUMANA
1023674488OtherAVESIS
1023674488OtherVACCN/OPTUM
K315180OtherCGS DME
1023674488OtherTHREE RIVERS PROVIDERS NETWORK
KY7100652140Medicaid
1023674488OtherMARCH VISION
6332209OtherAETNA
TNQ00181758OtherRR MEDICARE