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General NPI Number Information
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NPI Number | 1972885564
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Entity Type | Individual
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Provider Name | MATTHEW R MAHEK OD
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Gender | Male
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Dates
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Enumeration Date | 09/09/2011
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Last Update Date | 03/23/2022
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Provider Practice Location Address
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Address Line | 100 BREWSTER BLVD NAVAL HOSPITAL
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City | CAMP LEJEUNE
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State | NC
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Zip | 28547-2538
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Country | US
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Telephone | 910-450-4159
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Fax | 910-450-4194
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Provider Business Mailing Address
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Address Line | 100 BREWSTER BLVD NAVAL HOSPITAL
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City | CAMP LEJEUNE
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State | NC
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Zip | 28547-2538
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Country | US
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Telephone | 910-450-4159
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Fax | 910-450-4194
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 6055
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 152WC0802X
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Taxonomy Name | Corneal and Contact Management Optometrist
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License Number | 8581
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 8581
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License Number State | TX
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