Provider Demographics
NPI:1912081670
Name:MATSUZAKI, MATTHEW Y (OD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:Y
Last Name:MATSUZAKI
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 1:267 S EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-2717
Mailing Address - Country:US
Mailing Address - Phone:626-449-2020
Mailing Address - Fax:626-449-2095
Practice Address - Street 1:267 S EUCLID AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-2717
Practice Address - Country:US
Practice Address - Phone:626-449-2020
Practice Address - Fax:626-449-2095
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2008-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT5303TPL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT70005Medicare UPIN
CAOP5303Medicare PIN