Provider Demographics
NPI:1376636027
Name:MARTIN M MATUS OD
Entity type:Organization
Organization Name:MARTIN M MATUS OD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:INSURANCE BILLER
Authorized Official - Prefix:
Authorized Official - First Name:CORINNE
Authorized Official - Middle Name:
Authorized Official - Last Name:GORMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-293-7833
Mailing Address - Street 1:1046 S ARLINGTON HEIGHTS RD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-3139
Mailing Address - Country:US
Mailing Address - Phone:847-290-1131
Mailing Address - Fax:847-290-1146
Practice Address - Street 1:1046 S ARLINGTON HEIGHTS RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-3139
Practice Address - Country:US
Practice Address - Phone:847-290-1131
Practice Address - Fax:847-290-1146
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2015-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046-009573152W00000X
IL046-008214152W00000X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1609872076OtherNPI
1770651036OtherNPI
212675Medicare UPIN
DN6329Medicare PIN
1609872076OtherNPI
ILV07526Medicare UPIN
IL212675Medicare ID - Type Unspecified