Provider Demographics
NPI:1811091200
Name:ALLEN, MATTHEW JOSEPH (OD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:JOSEPH
Last Name:ALLEN
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 1:12033 CLEVELAND AVE NW
Mailing Address - Street 2:
Mailing Address - City:UNIONTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44685-8482
Mailing Address - Country:US
Mailing Address - Phone:330-699-2934
Mailing Address - Fax:330-699-1373
Practice Address - Street 1:12033 CLEVELAND AVE NW
Practice Address - Street 2:
Practice Address - City:UNIONTOWN
Practice Address - State:OH
Practice Address - Zip Code:44685-8482
Practice Address - Country:US
Practice Address - Phone:330-699-2934
Practice Address - Fax:330-699-1373
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-07
Last Update Date:2015-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5010/T1887152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0050541Medicaid
OH0050541Medicaid