Provider Demographics
NPI:1053394932
Name:GROSHART, MATTHEW E (OD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:E
Last Name:GROSHART
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 786
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-0786
Mailing Address - Country:US
Mailing Address - Phone:307-674-7611
Mailing Address - Fax:307-672-7777
Practice Address - Street 1:25 E GRINNELL PLZ
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-3930
Practice Address - Country:US
Practice Address - Phone:307-674-7611
Practice Address - Fax:307-672-7777
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY185T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY4371784AMedicare PIN
WYT83822Medicare UPIN