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Individual
MICHAEL MATHERNE
Active
Individual
MICHAEL MATHERNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
1839-773AT
LA
152W00000X
Optometrist
Primary
OPT33865TLG
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OPT33865TLG
BOARD OF OPTOMETRY
CA
Enumeration date
10/17/2016
Last updated
09/11/2019
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