Provider Demographics
NPI:1669447389
Name:LORTIE, MATTHEW RAYMOND (OD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:RAYMOND
Last Name:LORTIE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:601 FRANK SOTTILE BLVD
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401
Mailing Address - Country:US
Mailing Address - Phone:845-336-2058
Mailing Address - Fax:845-336-2304
Practice Address - Street 1:601 FRANK SOTTILE BLVD
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401
Practice Address - Country:US
Practice Address - Phone:845-336-2058
Practice Address - Fax:845-336-2304
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV52991152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist