Provider Demographics
NPI:1902327513
Name:AGNONE, MATTHEW JOHN (OD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:JOHN
Last Name:AGNONE
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 1:11225 S SAGINAW ST
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-1285
Mailing Address - Country:US
Mailing Address - Phone:810-694-3937
Mailing Address - Fax:810-694-9876
Practice Address - Street 1:11225 S SAGINAW ST
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-1285
Practice Address - Country:US
Practice Address - Phone:810-694-3937
Practice Address - Fax:810-694-9876
Is Sole Proprietor?:No
Enumeration Date:2017-07-05
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901005059152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist