Individual
DR. MATT L GRANTHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
101 SMITH AVE STE 2, POTEAU, OK 74953-2613
(918) 647-9283
(918) 649-0878
Mailing address
101 SMITH AVE STE 2, POTEAU, OK 74953-2613
(918) 647-9283
(918) 649-0878
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
XXXX
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100851340A
—
OK
05
—
100851340B
—
OK
05
—
200090590A
—
OK
05
—
200090590B
—
OK
Enumeration date
01/25/2007
Last updated
07/31/2025
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