Provider Demographics
NPI:1407207517
Name:WEN, MATTHEW MAOYOU (OD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:MAOYOU
Last Name:WEN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 WORSTER DR
Mailing Address - Street 2:
Mailing Address - City:MARLBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01752-5004
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5105 KINGS PLZ
Practice Address - Street 2:STORE #459
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-5218
Practice Address - Country:US
Practice Address - Phone:774-253-7810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-29
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008484152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist