National Provider Identifier
Keith Gilbert Mattoon, LICENSED OPTICIAN
Keith Gilbert Mattoon, LICENSED OPTICIAN is listed in the NPPES registry with a primary specialty of Optician in Lakewood, NY and a listed phone number of (716) 763-0954.
Profile Overview
- NPI
- 1366958142
- Provider Type
- Individual
- Primary Specialty
- Optician
- Enumeration Date
- December 16, 2017
- Last Updated
- December 16, 2017
Practice Location
- 350 E Fairmount Ave
- Lakewood, NY 14750-2134
Phone: (716) 763-0954
Specialties
- Optician (156FX1800X)
Full Record
- NPI
- 1366958142
- Entity Type
- Individual
- Last Name
- Mattoon
- First Name
- Keith
- Middle Name
- Gilbert
- Credential
- LICENSED OPTICIAN
- Mailing Street Address
- 350 E Fairmount Ave
- Mailing City
- Lakewood
- Mailing State
- NY
- Mailing ZIP Code
- 14750-2134
- Mailing Country
- US
- Mailing Phone
- (716) 763-0954
- Practice Street Address
- 350 E Fairmount Ave
- Practice City
- Lakewood
- Practice State
- NY
- Practice ZIP Code
- 14750-2134
- Practice Country
- US
- Practice Phone
- (716) 763-0954
- Practice Fax
- (716) 763-0953
- Enumeration Date
- December 16, 2017
- Last Updated
- December 16, 2017
- Sex
- Male
- Sole Proprietor
- No
- updated_by_file
- npidata_pfile_20050523-20260308.csv
- Taxonomies
- Optician (156FX1800X)