Provider Demographics
NPI:1912567876
Name:OZBEK, MATHEUS M
Entity Type:Individual
Prefix:
First Name:MATHEUS
Middle Name:M
Last Name:OZBEK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2716 LINCOLN DR
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113-1333
Mailing Address - Country:US
Mailing Address - Phone:651-631-9394
Mailing Address - Fax:
Practice Address - Street 1:2716 LINCOLN DR
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-1333
Practice Address - Country:US
Practice Address - Phone:651-631-9394
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-13
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9673152W00000X
MN3743152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist