Provider Demographics
NPI:1811901481
Name:DINSLAGE, MATTHEW WADE (OD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:WADE
Last Name:DINSLAGE
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 1:3702 23RD ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:NE
Mailing Address - Zip Code:68601-3023
Mailing Address - Country:US
Mailing Address - Phone:402-564-2020
Mailing Address - Fax:402-563-2020
Practice Address - Street 1:3702 23RD ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:NE
Practice Address - Zip Code:68601-3023
Practice Address - Country:US
Practice Address - Phone:402-564-2020
Practice Address - Fax:402-563-2020
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2018-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1257152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE37187OtherBLUE CROSS/ BLUE SHIELD OF NEBRASKA
NE10025562700Medicaid
NE37187OtherBLUE CROSS/ BLUE SHIELD OF NEBRASKA
NE37187OtherBLUE CROSS/ BLUE SHIELD OF NEBRASKA
NE10025562700Medicaid