Charles Richard Matti, O.D.
Individual provider Active NPI Optometrist · Grants Pass, OR
NPI 1720171432 · NPPES record last updated Mar 7, 2023
Key facts
- NPI
- 1720171432
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 1185ATI (OR)
- Practice address
- 1022 NW 6TH St.
Grants Pass, OR 97526 - Phone
- (541) 476-4545
- Fax
- (541) 479-5985
- NPI assigned
- Oct 2, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1185ATI | OR | MD | Optometrist |
| 1185 | OR | MD | Naturopath |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Eye Care Group of Southern Oregon, LLC | Optometrist | Past | Accepting new patients |
| Eye Care Group of Southern Oregon, LLC | Optometrist | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 1185ATI | OR | Yes |
Addresses
Primary practice location
1022 NW 6TH St.
Grants Pass, OR 97526
Mailing address
1022 NW 6TH St.
Grants Pass, OR 97526
Phone (541) 476-4545
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 122960 | Medicaid | OR |
Other providers in Grants Pass, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 7, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.