MEDICARE: MATSIX, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332H00000X	Eyewear Supplier	194286	CA

General Provider Information

NPI Number	:	1609291558
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MATSIX, LLC

Provider Business Mailing Address
First Line	:	5437 LAUREL CANYON BLVD
Second Line	:	SUITE 107
City	:	VALLEY VILLAGE
State	:	CA
Zip	:	91607-2181
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5437 LAUREL CANYON BLVD
Second Line	:	SUITE 107
City	:	VALLEY VILLAGE
State	:	CA
Zip	:	91607-2181
Country	:	US
Telephone Number	:	818-588-6744
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MARYANN REYES
Credential	:
Telephone Number	:	240-393-6287

Provider Enumeration Date	:	03/03/2014
Last Update Date	:	03/03/2014

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