Basic Information
| Provider Information | |||||||||
| NPI: | 1962681171 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | UBEDEI | ||||||||
| FirstName: | MATTHEW | ||||||||
| MiddleName: | SABO | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5955 ZEAMER AVENUE | ||||||||
| Address2: | 673 MDG | ||||||||
| City: | JBER | ||||||||
| State: | AK | ||||||||
| PostalCode: | 99506 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9075801035 | ||||||||
| FaxNumber: | 9075803203 | ||||||||
| Practice Location | |||||||||
| Address1: | 5955 ZEAMER AVENUE | ||||||||
| Address2: | 673 MDG | ||||||||
| City: | JBER | ||||||||
| State: | AK | ||||||||
| PostalCode: | 99506 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9075801035 | ||||||||
| FaxNumber: | 9075803203 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/24/2007 | ||||||||
| LastUpdateDate: | 12/11/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 7105T | TX | N | Eye and Vision Services Providers | Optometrist | 152W00000X | 329 | AK | Y | Eye and Vision Services Providers | Optometrist | 152W00000X | OD00004141 | WA | N | Eye and Vision Services Providers | Optometrist |
No ID Information.