1851733612 NPI number — DR. MATTHEW CODY LUBECK O.D.

Table of content: DR. MATTHEW CODY LUBECK O.D. (NPI 1851733612)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851733612 NPI number — DR. MATTHEW CODY LUBECK O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LUBECK
Provider First Name:
MATTHEW
Provider Middle Name:
CODY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1851733612
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/22/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12700 HILL COUNTRY GALLERIA BLVD
Provider Second Line Business Mailing Address:
SUITE S110
Provider Business Mailing Address City Name:
BEE CAVE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78738
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-263-0020
Provider Business Mailing Address Fax Number:
512-263-4623

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12700 HILL COUNTRY GALLERIA BLVD
Provider Second Line Business Practice Location Address:
SUITE S110
Provider Business Practice Location Address City Name:
BEE CAVE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78738
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-263-0020
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/22/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  8185-T , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)