Individual
MATTHEW GIFFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
5111 N MAIN ST REET, STE 200, MISHAWAKA, IN 46545
(574) 277-8121
Mailing address
8614 WESTWOOD CENTER DR FL 9, VIENNA, VA 22182-2442
(703) 847-8899
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
18003913A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201299850
—
IN
Enumeration date
07/01/2015
Last updated
05/20/2024
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