Provider Demographics
NPI:1184885345
Name:NEALE, MATTHEW D (MD)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:D
Last Name:NEALE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7096
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95267-0096
Mailing Address - Country:US
Mailing Address - Phone:209-956-7725
Mailing Address - Fax:209-956-7733
Practice Address - Street 1:992 COUNTRY CLUB RD
Practice Address - Street 2:STE101
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-6023
Practice Address - Country:US
Practice Address - Phone:541-687-1715
Practice Address - Fax:541-687-1690
Is Sole Proprietor?:No
Enumeration Date:2008-06-20
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD153772207W00000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR000WFBWCOtherMEDICARE IDENTIFICATION NUMBER