Provider Demographics
NPI:1457703191
Name:FIERRO, MATTHEW (OD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:
Last Name:FIERRO
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 1:2156 E WILLIAMS FIELD RD STE 104
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-0733
Mailing Address - Country:US
Mailing Address - Phone:480-814-2584
Mailing Address - Fax:480-963-9391
Practice Address - Street 1:2156 E WILLIAMS FIELD RD STE 104
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-0733
Practice Address - Country:US
Practice Address - Phone:480-814-2584
Practice Address - Fax:480-963-9391
Is Sole Proprietor?:No
Enumeration Date:2016-07-06
Last Update Date:2016-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2134152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist