Provider Demographics
NPI:1205501095
Name:STEIN, MATTHEW (OD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:
Last Name:STEIN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 43RD AVE S # AVENEUES
Mailing Address - Street 2:
Mailing Address - City:MOORHEAD
Mailing Address - State:MN
Mailing Address - Zip Code:56560-6727
Mailing Address - Country:US
Mailing Address - Phone:701-388-1581
Mailing Address - Fax:
Practice Address - Street 1:2601 UNIVERSITY DR S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-6025
Practice Address - Country:US
Practice Address - Phone:701-235-5200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-12
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND788152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist