Basic Information
| Provider Information | |||||||||
| NPI: | 1205816709 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MATEIK | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | JOSEPH | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13 WALNUT ST | ||||||||
| Address2: | |||||||||
| City: | WINCHENDON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 014751626 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9782972020 | ||||||||
| FaxNumber: | 9782970486 | ||||||||
| Practice Location | |||||||||
| Address1: | 13 WALNUT ST | ||||||||
| Address2: | |||||||||
| City: | WINCHENDON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 014751626 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9782972020 | ||||||||
| FaxNumber: | 9782970486 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/19/2006 | ||||||||
| LastUpdateDate: | 08/07/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 2292 | MA | Y | Eye and Vision Services Providers | Optometrist | 152WC0802X | 2292 | MA | N | Eye and Vision Services Providers | Optometrist | Corneal and Contact Management |
ID Information
| ID | Type | State | Issuer | Description | 0310379 | 05 | MA | MEDICAID | 41238 | 01 | MA | FALLON COMMUNITY HEALTH | OTHER | 15655 | 01 | MA | HARVARD PILGRIM | OTHER | W20137 | 01 | MA | BLUE CROSS BLUE SHIELD | OTHER | 23568 | 01 | MA | CIGNA | OTHER | 722509 | 01 | MA | TUFTS | OTHER |