Matt Grantham, OD, PC

Primary specialty

OptometristTaxonomy code 152W00000X

Legal business name

MATT GRANTHAM, OD, PC

Practice address

101 Smith Ave
Suite #2
Poteau, OK 74953-2613

Phone

(918) 647-9283

Fax

(918) 649-0878

NPI assigned

Oct 25, 2006

Organization subpart

No

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

Authorized official

Name

Mrs. Dana M Grantham

Title

Office Manager

Phone

(918) 647-9283

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Grantham Eye Clinic Doing business as

Medicare fee-for-service enrollment

Enrolled in OK

Enrollment records 1

Other NPIs on the same Medicare enrollment 1

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

• Matt Grantham, OD, PC

  • Optometrist
  • Poteau, OK
  • NPI 1124174966

  O20120213000288

  Same enrollment

Locations

Practitioners 1

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

• Matt L Grantham, O.D.

  • Optometrist
  • Poteau, OK
  • NPI 1255487393
  NPD

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

{
    "created_epoch": "1161734400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1707177600000",
    "number": "1477637643",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 SMITH AVE",
            "address_2": "SUITE #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",
            "address_2": "SUITE #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": "2006-10-25",
        "last_updated": "2024-02-06",
        "certification_date": "2024-02-06",
        "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",
        "authorized_official_name_prefix": "Mrs."
    },
    "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": "100851340B",
            "state": "OK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200090590B",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Grantham Eye Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Tyna Lyndelle Martin
• Cheri L Mathews, BA/PSRS
• Lindsay Marie Matos
• Randall Joseph Matos, DPM
• Matt Grantham, OD, PC
• William Burt-Lewis Matthews, PHARM. D.
• Jeremiah Bilyeu Maxwell
• Kendra Janai Maxwell, MA, LPC CANDIDATE
• Sarah L Maxwell, P TA
• Elijah Parker McAlvain

• Optometrist in Poteau, OK
• Providers in Poteau, OK by specialty
• Optometrist in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2024; 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.