Provider Demographics
NPI:1811929805
Name:POLLASTRINI, MATTHEW J (OD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:J
Last Name:POLLASTRINI
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1215 AMELIA DR APT 4
Mailing Address - Street 2:
Mailing Address - City:CEDAR FALLS
Mailing Address - State:IA
Mailing Address - Zip Code:50613-7982
Mailing Address - Country:US
Mailing Address - Phone:319-240-4173
Mailing Address - Fax:
Practice Address - Street 1:105 20TH ST NW
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:IA
Practice Address - Zip Code:50677-2059
Practice Address - Country:US
Practice Address - Phone:319-352-4516
Practice Address - Fax:319-352-0291
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2010-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA2017152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1811929805OtherWELLMARK
U52050Medicare UPIN
IA1811929805OtherWELLMARK