Provider Demographics
NPI:1902991193
Name:CORSO, MATTHEW P (OD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:P
Last Name:CORSO
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 1:3373 LAKE ARIEL HWY
Mailing Address - Street 2:SUITE C
Mailing Address - City:HONESDALE
Mailing Address - State:PA
Mailing Address - Zip Code:18431-1174
Mailing Address - Country:US
Mailing Address - Phone:570-253-6551
Mailing Address - Fax:570-253-6553
Practice Address - Street 1:3373 LAKE ARIEL HWY
Practice Address - Street 2:SUITE C
Practice Address - City:HONESDALE
Practice Address - State:PA
Practice Address - Zip Code:18431-1174
Practice Address - Country:US
Practice Address - Phone:570-253-6551
Practice Address - Fax:570-253-6553
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001720152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PACO1744970OtherBLUE CROSS/BLUE SHIELD
PAPA91720OtherVBA
PA022505OtherNVA
PA819424OtherFIRST PRIORITY
PA94935OtherGEISINGER
PA1013083160001Medicaid
PAPA91720OtherVBA
PA092753Medicare ID - Type Unspecified