Provider Demographics
NPI:1770965097
Name:EDWARD L. MATUSIK, OD PA
Entity type:Organization
Organization Name:EDWARD L. MATUSIK, OD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:L
Authorized Official - Last Name:MATUSIK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:407-859-1071
Mailing Address - Street 1:1017 W OAK RIDGE RD STE A
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32809-4723
Mailing Address - Country:US
Mailing Address - Phone:407-859-1071
Mailing Address - Fax:407-859-1075
Practice Address - Street 1:1017 W OAK RIDGE RD STE A
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32809-4723
Practice Address - Country:US
Practice Address - Phone:407-859-1071
Practice Address - Fax:407-859-1075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-23
Last Update Date:2015-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC1238152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty