Provider Demographics
NPI:1659752368
Name:PORN, MATTHEW (OD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:
Last Name:PORN
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 1:1701 MARLENE DR
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68512-9250
Mailing Address - Country:US
Mailing Address - Phone:402-841-1065
Mailing Address - Fax:
Practice Address - Street 1:2801 PINE LAKE RD STE J
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-6041
Practice Address - Country:US
Practice Address - Phone:402-420-6644
Practice Address - Fax:402-420-2926
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-18
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA078718152W00000X
NE1440152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist