Provider Demographics
NPI:1548323553
Name:PIPER, MATTHEW S (OD)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:S
Last Name:PIPER
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 1:91 E MARION ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT GILEAD
Mailing Address - State:OH
Mailing Address - Zip Code:43338-1434
Mailing Address - Country:US
Mailing Address - Phone:419-946-6881
Mailing Address - Fax:419-946-6871
Practice Address - Street 1:91 E MARION ST
Practice Address - Street 2:
Practice Address - City:MOUNT GILEAD
Practice Address - State:OH
Practice Address - Zip Code:43338-1434
Practice Address - Country:US
Practice Address - Phone:419-946-6881
Practice Address - Fax:419-946-6871
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5651152W00000X
AZ1531152W00000X
TN2655152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0071049Medicaid
OH0071049Medicaid