Provider Demographics
NPI:1679262836
Name:BRILLON, MATTHEW (OD)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:BRILLON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 DOTYS MILL RD
Mailing Address - Street 2:
Mailing Address - City:ACUSHNET
Mailing Address - State:MA
Mailing Address - Zip Code:02743-1230
Mailing Address - Country:US
Mailing Address - Phone:508-717-5902
Mailing Address - Fax:
Practice Address - Street 1:500 FAUNCE CORNER RD
Practice Address - Street 2:
Practice Address - City:DARTMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02747-1278
Practice Address - Country:US
Practice Address - Phone:508-717-0270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-03
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAOPT5630152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist