Individual provider Active NPI

Matthew Muto, O.D.

  • Optometrist
  • Boise, ID
National Provider Identifier
1659721314
Registry record updated Jun 14, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
ODP-100366 Issued in ID
Practice address
1175 W Boise Ave
Boise, ID 83706-3503
Phone
(208) 384-9194
Fax
(208) 384-9237
NPI assigned
Jun 14, 2016
Last updated
Jun 14, 2016By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 14, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X ODP-100366 ID Primary

Addresses

Primary practice location

1175 W Boise Ave
Boise, ID 83706-3503

Mailing address

1175 W Boise Ave
Boise, ID 83706-3503
Phone (208) 384-9194

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160803001643 ID Practitioner - Optometry 9335433051 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Idaho Eyecare CenterGroup PAC ID 9335105311, 4 clinicians

Practice addresses (Care Compare)

1175 W Boise Ave
Boise, ID 83706-3503
Phone (208) 384-9194

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
ODP-100366IDMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Idaho Eyecare Center Optometrist CurrentSince Jun 27, 2016 Accepting new patients

Locations

1175 W Boise Ave
Boise, ID 83706
Phone (208) 384-9194

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1465862400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1465862400000",
    "number": "1659721314",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1175 W BOISE AVE",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837063503",
            "telephone_number": "208-384-9194",
            "fax_number": "208-384-9237"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1175 W BOISE AVE",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837063503",
            "telephone_number": "208-384-9194",
            "fax_number": "208-384-9237"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MUTO",
        "first_name": "MATTHEW",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-06-14",
        "last_updated": "2016-06-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "ID",
            "license": "ODP-100366",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boise, ID

Sources for this page

Verify at the official NPI Registry.