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Individual
DR. MATTHEW WOODRUFF OBLAD
Active
Individual
DR. MATTHEW WOODRUFF OBLAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
1510
AZ
152W00000X
Optometrist
Primary
OPT 12847 TPA
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
73-1728125
TAX IDENFICATION NUMBER
CA
01
—
D3912075
DRIVERS LICENSE NUMBER
CA
05
—
GSD005170
—
CA
01
—
SD0128470
MEDICARE ID
—
05
—
SD0128470
—
CA
Enumeration date
07/03/2006
Last updated
03/07/2023
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