Individual provider Active NPI

Matthew Raymond Lortie, OD

  • Optometrist
  • Kingston, NY
National Provider Identifier
1669447389
Registry record updated Sep 13, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
TUV52991 Issued in NY
Practice address
601 Frank Sottile Blvd
Kingston, NY 12401
Phone
(845) 336-2058
Fax
(845) 336-2304
NPI assigned
Feb 17, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 13, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X TUV52991 NY Primary

Addresses

Primary practice location

601 Frank Sottile Blvd
Kingston, NY 12401

Mailing address

601 Frank Sottile Blvd
Kingston, NY 12401
Phone (845) 336-2058

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
TUV52991NYMDOptometrist

NPI Registry JSON

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

{
    "created_epoch": "1140134400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1473724800000",
    "number": "1669447389",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "601 FRANK SOTTILE BLVD",
            "city": "KINGSTON",
            "state": "NY",
            "postal_code": "12401",
            "telephone_number": "845-336-2058",
            "fax_number": "845-336-2304"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 FRANK SOTTILE BLVD",
            "city": "KINGSTON",
            "state": "NY",
            "postal_code": "12401",
            "telephone_number": "845-336-2058",
            "fax_number": "845-336-2304"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LORTIE",
        "first_name": "MATTHEW",
        "middle_name": "RAYMOND",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-17",
        "last_updated": "2016-09-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NY",
            "license": "TUV52991",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kingston, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2016; 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.