Provider Demographics
NPI:1851733612
Name:LUBECK, MATTHEW CODY (OD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:CODY
Last Name:LUBECK
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12700 HILL COUNTRY GALLERIA BLVD
Mailing Address - Street 2:SUITE S110
Mailing Address - City:BEE CAVE
Mailing Address - State:TX
Mailing Address - Zip Code:78738
Mailing Address - Country:US
Mailing Address - Phone:512-263-0020
Mailing Address - Fax:512-263-4623
Practice Address - Street 1:12700 HILL COUNTRY GALLERIA BLVD
Practice Address - Street 2:SUITE S110
Practice Address - City:BEE CAVE
Practice Address - State:TX
Practice Address - Zip Code:78738
Practice Address - Country:US
Practice Address - Phone:512-263-0020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-22
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8185-T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist