Provider Demographics
NPI:1669433249
Name:OZMENT, MATTHEW E (OD)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:E
Last Name:OZMENT
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 1:1950 OLD GALLOWS RD STE 520
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3970
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2500 WEST NEW ORLEANS
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74011
Practice Address - Country:US
Practice Address - Phone:405-248-6306
Practice Address - Fax:405-598-6558
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2021-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKOK2368152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100847000BMedicaid
OK47-0898450OtherSUPERIOR VISION HARRAH
OKOK2368OtherEYEMED TECUMSEH
OKOP1609OtherEYEMED
OKTE18668OtherSPECTERA TECUMSEH
OKTECPLLCOtherVSP TECUMSEH
OK4054540099OtherVSP HARRAH
OKOK2368OtherEYEMED
OKHE28037OtherHARRAH SPECTERA
OKHE28037OtherHARRAH SPECTERA
OKOP1609OtherEYEMED
OK47-0898450OtherSUPERIOR VISION HARRAH
OK4808540001Medicare NSC