Provider Demographics
NPI:1780603142
Name:LITTLEJOHN, MATTHEW (OD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:
Last Name:LITTLEJOHN
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 1:1968 N PEART RD STE 12
Mailing Address - Street 2:
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85122-2496
Mailing Address - Country:US
Mailing Address - Phone:520-836-9606
Mailing Address - Fax:520-836-3964
Practice Address - Street 1:1968 N PEART RD STE 12
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85122-2496
Practice Address - Country:US
Practice Address - Phone:520-836-9606
Practice Address - Fax:520-836-3964
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1525152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ387419Medicaid
D09166OtherRAILROAD MEDICARE
AZDU5966OtherRAILROAD MEDICARE
AZ152W00000XOtherTAXONOMY
AZZ162082Medicare PIN
AZZ162081Medicare PIN
AZDU5966OtherRAILROAD MEDICARE