Provider Demographics
NPI:1700165719
Name:WEBB, MATTHEW RAYMOND (OD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:RAYMOND
Last Name:WEBB
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 1:3450 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87402-5327
Mailing Address - Country:US
Mailing Address - Phone:505-325-7070
Mailing Address - Fax:505-325-5812
Practice Address - Street 1:3450 E MAIN ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87402-5327
Practice Address - Country:US
Practice Address - Phone:505-325-7070
Practice Address - Fax:505-325-5812
Is Sole Proprietor?:No
Enumeration Date:2011-08-08
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2896152W00000X
NMOPT721152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist