Organization
MATTHEW R SULLIVAN OD PC
Active
Other names
Premier Eye Center
Organization subpart
No
Provider details
NPI number
Authorized official
TRACY HOLMES SULLIVAN (OFFICE MANAGER)
(928) 778-3937
Entity
Organization
Contact information
Practice address
980 WILLOW CREEK ROAD, SUITE 202, PRESCOTT, AZ 86301
(928) 778-3937
(928) 778-3939
Mailing address
980 WILLOW CREEK ROAD, SUITE 202, PRESCOTT, AZ 86301
(928) 778-3937
(928) 778-3939
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1102
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4244670001
DMERC
AZ
05
—
578966
—
AZ
Enumeration date
10/25/2007
Last updated
03/30/2021
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