Keith Gilbert Mattoon, LICENSED OPTICIAN

Primary specialty

OpticianTaxonomy code 156FX1800X

License

008518 Issued in NY

Practice address

350 E Fairmount Ave
Lakewood, NY 14750-2134

Phone

(716) 763-0954

Fax

(716) 763-0953

NPI assigned

Dec 16, 2017

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1513382400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1513382400000",
    "number": "1366958142",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "350 E FAIRMOUNT AVE",
            "city": "LAKEWOOD",
            "state": "NY",
            "postal_code": "147502134",
            "telephone_number": "716-763-0954"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "350 E FAIRMOUNT AVE",
            "city": "LAKEWOOD",
            "state": "NY",
            "postal_code": "147502134",
            "telephone_number": "716-763-0954",
            "fax_number": "716-763-0953"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATTOON",
        "first_name": "KEITH",
        "middle_name": "GILBERT",
        "credential": "LICENSED OPTICIAN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-12-16",
        "last_updated": "2017-12-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "156FX1800X",
            "taxonomy_group": "",
            "desc": "Technician/Technologist, Optician",
            "state": "NY",
            "license": "008518",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Karen Wise Lindeman, PH.D.
• Thomas J Lovecchio, BS PHARMACY
• Leanna Luka, LCSW
• Angela Lunz
• Natalie Maggio, LMT
• Shahnawaz Meer, M.D.
• Bethanie Anne Milner, R.N
• Donna B Moynihan, M.S. CCC SLP
• Painted Post Properties, Inc.
• Gretchen Parker, MS SPEC ED

• All providers in Lakewood, NY
• Optician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.