Individual
KEITH GILBERT MATTOON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LICENSED OPTICIAN
Contact information
Practice address
350 E FAIRMOUNT AVE, LAKEWOOD, NY 14750-2134
(716) 763-0954
(716) 763-0953
Mailing address
350 E FAIRMOUNT AVE, LAKEWOOD, NY 14750-2134
(716) 763-0954
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
008518
NY
Other
Enumeration date
12/16/2017
Last updated
12/16/2017
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