Matthew R Sullivan OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

1102 Issued in AZ

Legal business name

MATTHEW R SULLIVAN OD

Practice address

980 Willow Creek Road
Suite 202
Prescott, AZ 86301

Phone

(928) 778-3937

Fax

(928) 778-3939

NPI assigned

Oct 25, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Matthew Ryan Sullivan, ODNPI 1053311472

Title

OD

Phone

(928) 778-3937

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Premier Eye Center Doing business as

Medicare fee-for-service enrollment

Enrolled in AZ2 enrollments

Enrollment records 2

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Locations

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Matthew Ryan Sullivan, OD

  • Optometrist
  • Prescott, AZ
  • NPI 1053311472
  Medicare reassignment Care Compare group NPD Authorized official
• Shane Ryan Sanders, OD

  • Optometrist
  • Prescott, AZ
  • NPI 1396221230
  Medicare reassignment Care Compare group NPD
• Kelsie Stevens, OD

  • Optometrist
  • Phoenix, AZ
  • NPI 1689283830
  Medicare reassignment Care Compare group NPD
• Lauren West, OD

  • Optometrist
  • Prescott, AZ
  • NPI 1740705037
  Medicare reassignment Care Compare group NPD
• Laura Grant, MD

  • Ophthalmology Physician
  • Tempe, AZ
  • NPI 1194174847
  NPD (past)
• Bryan Grossman, OD

  • Optometrist
  • Sacaton, AZ
  • NPI 1801467790
  NPD (past)
• Camille M Hylton, MD

  • Ophthalmology Physician
  • Tempe, AZ
  • NPI 1629019732
  NPD (past)
• Jon A. Konti, M.D.

  • Ophthalmology Physician
  • Tempe, AZ
  • NPI 1417147141
  NPD (past)
• Lisa Ann Mansueto, M.D.

  • Ophthalmic Plastic and Reconstructive Surgery Physician
  • Tempe, AZ
  • NPI 1396742797
  NPD (past)
• Bertram T Matsumoto, MD

  • Ophthalmology Physician
  • Tempe, AZ
  • NPI 1477557494
  NPD (past)
• Danielle Remington, O.D.

  • Optometrist
  • Tempe, AZ
  • NPI 1780098806
  NPD (past)
• Richard Leslie Sherry, M.D.

  • Ophthalmology Physician
  • Tempe, AZ
  • NPI 1588656276
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1193270400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1779148800000",
    "number": "1285813360",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "980 WILLOW CREEK RD STE 202",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "863011616",
            "telephone_number": "928-778-3937",
            "fax_number": "928-778-3939"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "980 WILLOW CREEK ROAD",
            "address_2": "SUITE 202",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "86301",
            "telephone_number": "928-778-3937",
            "fax_number": "928-778-3939"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MATTHEW R SULLIVAN OD",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-25",
        "last_updated": "2026-05-19",
        "certification_date": "2026-05-19",
        "status": "A",
        "authorized_official_last_name": "SULLIVAN",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_middle_name": "RYAN",
        "authorized_official_title_or_position": "OD",
        "authorized_official_telephone_number": "928-778-3937",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "AZ",
            "license": "1102",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DMERC",
            "identifier": "4244670001",
            "state": "AZ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "578966",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Premier Eye Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Renee Elizabeth Mascher, L.C.S.W
• Annmarie Massimo, OGNP
• Douglas B. Masson, M.D.
• Stacy E Masten, M.S.W., L.C.S.W.
• John Michael Blanco Mata, NP
• Paula Elaine Matthew, LM CPM
• Jessica T Matthews, MD
• Anna Mattson, AGACNP
• Carrie Maupin, FNP-BC
• Clay C Maupin, D.D.S.

• Optometrist in Prescott, AZ
• Providers in Prescott, AZ by specialty
• Optometrist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.