Individual
JAY KENNETH MATTHEIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
11370 ANDERSON ST STE 1800, LOMA LINDA, CA 92354-3450
(909) 558-2154
(909) 558-2180
Mailing address
11370 ANDERSON ST STE 1800, LOMA LINDA, CA 92354-3450
(909) 558-2154
(909) 558-2180
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
14270
NV
207W00000X
Ophthalmology Physician
Primary
G66270
CA
207W00000X
Ophthalmology Physician
ME56477
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100527518
—
NV
01
—
1801843685
GROUP NPI#
NV
01
—
P01074697
RR MEDICARE PTAN
NV
Enumeration date
10/24/2005
Last updated
08/17/2023
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