Organization Active NPI

Matt Grantham, OD, PC

  • Optometrist
  • Poteau, OK
National Provider Identifier
1124174966
Registry record updated Jul 31, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
MATT GRANTHAM, OD, PC
Practice address
101 Smith Ave Ste 2
Poteau, OK 74953-2613
Phone
(918) 647-9283
Fax
(918) 649-0878
NPI assigned
Jan 26, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 31, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dana M Grantham
Title
Office Manager
Phone
(918) 647-9283

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X Primary

Addresses

Primary practice location

101 Smith Ave Ste 2
Poteau, OK 74953-2613

Mailing address

101 Smith Ave Ste 2
Poteau, OK 74953-2613
Phone (918) 647-9283

Other identifiers 2

IdentifierTypeStateIssuer
100851340AMedicaidOK
200090590AMedicaidOK

Other names 1

  • Grantham Eye Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20100930006180 OK DME Supplier - Physician - Optometrist 9234346677 Practice locations: Wilburton, OK
O20120213000288 OK Part B Supplier - Clinic/Group Practice 9234346677 Receives reassigned benefits from 1 practitioner
1 other NPI on this enrollment
Practice locations: Poteau, OK

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1169769600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1753920000000",
    "number": "1124174966",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 SMITH AVE STE 2",
            "city": "POTEAU",
            "state": "OK",
            "postal_code": "749532613",
            "telephone_number": "918-647-9283",
            "fax_number": "918-649-0878"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 SMITH AVE STE 2",
            "city": "POTEAU",
            "state": "OK",
            "postal_code": "749532613",
            "telephone_number": "918-647-9283",
            "fax_number": "918-649-0878"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MATT GRANTHAM, OD, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-26",
        "last_updated": "2025-07-31",
        "certification_date": "2025-07-31",
        "status": "A",
        "authorized_official_last_name": "GRANTHAM",
        "authorized_official_first_name": "DANA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "918-647-9283"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100851340A",
            "state": "OK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200090590A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Grantham Eye Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Poteau, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.