Provider Demographics
NPI:1265597066
Name:HESSE, MATT J (OD)
Entity type:Individual
Prefix:
First Name:MATT
Middle Name:J
Last Name:HESSE
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 1:78 BARNES DR
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:KY
Mailing Address - Zip Code:42633-9002
Mailing Address - Country:US
Mailing Address - Phone:606-348-3355
Mailing Address - Fax:606-348-5665
Practice Address - Street 1:211 CUMBERLAND XING
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:KY
Practice Address - Zip Code:42633-9000
Practice Address - Country:US
Practice Address - Phone:606-348-3355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-22
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1512DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY77000396Medicaid
KY77000396Medicaid
9367501Medicare ID - Type Unspecified
KY4310630001Medicare NSC