Provider Demographics
NPI:1801588967
Name:EIDOM, MATTHEW (OD)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:EIDOM
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 1:3580 WESTGATE
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW PARK
Mailing Address - State:OH
Mailing Address - Zip Code:44126-1300
Mailing Address - Country:US
Mailing Address - Phone:440-356-4020
Mailing Address - Fax:440-356-4022
Practice Address - Street 1:3580 WESTGATE
Practice Address - Street 2:
Practice Address - City:FAIRVIEW PARK
Practice Address - State:OH
Practice Address - Zip Code:44126-1300
Practice Address - Country:US
Practice Address - Phone:440-356-4020
Practice Address - Fax:440-356-4022
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-25
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOPT.007165152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist