Individual
MATTHEW SISSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
901 NW CARLON AVE STE 2, BEND, OR 97703-2636
(541) 382-3242
Mailing address
901 NW CARLON AVE STE 2, BEND, OR 97703-2636
(804) 317-9401
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
4310ATI
OR
152W00000X
Optometrist
812
NV
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1255616306
—
NV
Enumeration date
10/19/2011
Last updated
07/21/2022
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