Provider Demographics
NPI:1265514665
Name:S MATTHEW BUCHANAN OD PC
Entity type:Organization
Organization Name:S MATTHEW BUCHANAN OD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:S MATHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:BUCHANAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:719-495-5904
Mailing Address - Street 1:5018 PETRIFIED FOREST TRL
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-2911
Mailing Address - Country:US
Mailing Address - Phone:719-488-6736
Mailing Address - Fax:719-282-3081
Practice Address - Street 1:8540 SCARBOROUGH DRIVE
Practice Address - Street 2:SUITE 240
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920
Practice Address - Country:US
Practice Address - Phone:719-495-5904
Practice Address - Fax:719-282-3081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC806806Medicare PIN