Provider Demographics
NPI:1295152379
Name:POWERS, MATTHEW ARMSTRONG (MD, MBA)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:ARMSTRONG
Last Name:POWERS
Suffix:
Gender:M
Credentials:MD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3536 MENDOCINO AVE STE 380
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-3612
Mailing Address - Country:US
Mailing Address - Phone:707-575-5353
Mailing Address - Fax:707-578-0522
Practice Address - Street 1:3536 MENDOCINO AVE
Practice Address - Street 2:STE 380
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-3612
Practice Address - Country:US
Practice Address - Phone:720-848-0000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-26
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0060710207WX0107X
390200000X
CAA139016207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program