KEITH GILBERT MATTOON (NPI# 1366958142) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1366958142 |
| Entity Type | Individual |
| Full Name | KEITH GILBERT MATTOON |
| Credential | LICENSED OPTICIAN |
| Practice Address |
350 E Fairmount Ave Lakewood NY 14750-2134 |
| Practice Telephone | 7167630954 |
| Practice Fax Number | 7167630953 |
| Mailing Telephone | 7167630954 |
| Enumeration Date | 2017-12-16 |
| Last Update Date | 2017-12-16 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 156FX1800X |
Technician/Technologist Specialization: Optician |
008518 | NY | Eye and Vision Services Providers |
| Street Address |
350 E FAIRMOUNT AVE |
| City | LAKEWOOD |
| State | NY |
| Zip Code | 14750-2134 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255358313 | Wal-mart Stores East Lp | Durable Medical Equipment & Medical Supplies | 350 E Fairmount Ave, Lakewood, NY 14750-2134 | 2006-07-16 |
| 1053500603 | Michael Philip Swanson | Pharmacist | 350 E Fairmount Ave, Lakewood, NY 14750-2134 | 2007-10-19 |
| 1699869040 | Kevin Joseph Kartesz | Optometrist | 350 E Fairmount Ave, Lakewood, NY 14750-2134 | 2006-10-02 |
| 1538269030 | Anne Marie Brunenavs | Optometrist | 350 E Fairmount Ave, Lakewood, NY 14750-2134 | 2006-09-24 |
| 1497862916 | Wal-mart Stores East, Lp | Technician/Technologist | 350 E Fairmount Ave, Lakewood, NY 14750-2134 | 2006-08-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699163147 | Craig Richards | Physician Assistant | 390 E Fairmount Ave, Lakewood, NY 14750 | 2015-01-07 |
| 1982849659 | Syed Ali Raza Shamsi | Psychiatry & Neurology | 305 E. Fairmont Avenue, Unit 7, Lakewood, NY 14750 | 2008-12-10 |
| 1942417977 | Stephen C Barresi | Physician Assistant | Chd Meridian Healthcare, Jep, 4720 Bakerst, Ext., Lakewood, NY 14750 | 2007-05-17 |
| 1295947117 | Harold Ronald Carlson | Dentist | 2 East Main Street, Suite 115, Falconer, NY 14750 | 2007-05-04 |
| 1194865907 | David William Todd | Dentist | 120 Southwestern Dr, Lakewood, NY 14750 | 2007-02-08 |
| 1730271248 | Lee Ryan Anderson | Dentist | 909 Hunt Road, Lakewood, NY 14750 | 2006-09-29 |
| 1962416362 | Us Vision Optical Inc | Eyewear Supplier (Equipment, not the service) | Rt 394 Mall Blvd, Lakewood, NY 14750 | 2006-07-28 |
| 1518925437 | Israr A Abbasi | Psychiatry & Neurology | 305 E Fairmount Ave, Lakewood, NY 14750 | 2006-05-02 |
| 1992771190 | Robert Gibbon Jr. | Psychiatry & Neurology | 92 W. Summit St., Lakewood, NY 14750 | 2006-02-27 |
| 1295213684 | Allison Claire Munella | Physician Assistant | 305 E Fairmount Ave, Lakewood, NY 14750 | 2018-07-30 |
| Find all providers in zip 14750 | ||||
| Taxonomy Code | 156FX1800X |
| Grouping | Eye and Vision Services Providers |
| Classification | Technician/Technologist |
| Specialization | Optician |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003315417 | Cvs Aoc Corporation | Technician/Technologist | 5505 Carson St # 8878, Lakewood, CA 90713-3004 | 2018-02-12 |
| 1437665783 | Cvs Aoc Corporation | Technician/Technologist | 4909 Paramount Blvd # 5014, Lakewood, CA 90712-2903 | 2017-12-22 |
| 1427588011 | National Vision, Inc. | Technician/Technologist | 4429 Candlewood St, Lakewood, CA 90712-1736 | 2017-06-15 |
| 1417309535 | Lawrence Klapper | Technician/Technologist | 398 Clifton Ave, Lakewood, NJ 08701-3269 | 2016-07-13 |
| 1508231044 | Tae H Bae | Technician/Technologist | 8718 S Tacoma Way Ste C, Lakewood, WA 98499-4597 | 2015-12-09 |
| 1306247614 | Jacob Klein | Technician/Technologist | 1703 Clifton Ave, Lakewood, NJ 08701-1202 | 2014-09-07 |
| 1003237835 | Jennifer H Truong | Technician/Technologist | 11421 Carson St Ste D, Lakewood, CA 90715-2500 | 2013-12-20 |
| 1649502956 | Jeffrey Abramowitz | Technician/Technologist | 222 River Ave, Lakewood, NJ 08701-4807 | 2010-02-11 |
| 1548401763 | Esther M Blumenkrantz | Technician/Technologist | 30 Gefen Dr, Lakewood, NJ 08701-3596 | 2009-03-18 |
| 1528253358 | Robert Charles Michnoff | Technician/Technologist | 6 West Spruce Street, Vision Eyewear, Lakewood, NJ 08701-5007 | 2007-09-14 |
| Find all providers in LAKEWOOD | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.