Provider Demographics
NPI:1811937865
Name:BAILEY, MATTHEW JAMES (OD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:JAMES
Last Name:BAILEY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:113 COUNTRY CLUB DR NE
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-2935
Mailing Address - Country:US
Mailing Address - Phone:704-786-7600
Mailing Address - Fax:704-792-2131
Practice Address - Street 1:113 COUNTRY CLUB DR NE
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-2935
Practice Address - Country:US
Practice Address - Phone:704-786-7600
Practice Address - Fax:704-792-2131
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2008152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5904045Medicaid
NCNC2008OtherEYE MED
NC093U4OtherBCBS OF NC
NC5904045Medicaid