Individual
MR. MATTHEW PAUL AXLINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD OPTOMETRIST
Contact information
Practice address
905 S POPLAR ST, BUCYRUS, OH 44820-2663
(419) 562-3822
(419) 562-9939
Mailing address
399 E CHURCH ST, MARION, OH 43302-4143
(740) 387-8414
(740) 382-9434
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
5520
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2522121
—
OH
Enumeration date
08/22/2006
Last updated
05/19/2020
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