Provider Demographics
NPI:1598835662
Name:MOTTELER, MATTHEW BYNUM (OD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:BYNUM
Last Name:MOTTELER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:324 N HIGHWAY 16
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:NC
Mailing Address - Zip Code:28037-8012
Mailing Address - Country:US
Mailing Address - Phone:704-918-1232
Mailing Address - Fax:704-483-6136
Practice Address - Street 1:324 N HIGHWAY 16
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:NC
Practice Address - Zip Code:28037-8012
Practice Address - Country:US
Practice Address - Phone:704-483-2263
Practice Address - Fax:704-483-6136
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2036152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist