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Contact Information

MATTHEW R SULLIVAN OD
980 WILLOW CREEK ROAD
SUITE 202
PRESCOTT, AZ86301
 Phone: 928-778-3937
 Fax: 928-778-3939
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Optometrist

152W00000X 41 Optometry
Indicates primary specialty

NPI Profile & details for MATTHEW R SULLIVAN OD

NPI # 1285813360
LBN Legal business name MATTHEW R SULLIVAN OD
Authorized official MATTHEW SULLIVAN - (OD)
Entity Organization
Organization subpart 1 No
Enumeration date 10/25/2007
Last updated 05/19/2026 - About 2 weeks ago
Identifiers
AZ License # 1102
AZ Medicaid 578966
AZ Other 4244670001 DMERC
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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