Provider Demographics
NPI:1548766322
Name:OKON, MATTHEW C (CPO)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:C
Last Name:OKON
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1S376 SUMMIT AVE
Mailing Address - Street 2:COURT E
Mailing Address - City:OAKBROOK TERRACE
Mailing Address - State:IL
Mailing Address - Zip Code:60181-3985
Mailing Address - Country:US
Mailing Address - Phone:630-424-0392
Mailing Address - Fax:630-424-0467
Practice Address - Street 1:8641 W 95TH ST
Practice Address - Street 2:
Practice Address - City:HICKORY HILLS
Practice Address - State:IL
Practice Address - Zip Code:60457-1730
Practice Address - Country:US
Practice Address - Phone:708-599-8336
Practice Address - Fax:708-599-2792
Is Sole Proprietor?:No
Enumeration Date:2018-04-02
Last Update Date:2018-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL213000195222Z00000X
IL211000204224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist