Provider Demographics
NPI:1114170339
Name:THAI, MATTHEW S (OD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:S
Last Name:THAI
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 1:4700 SETON CENTER PKWY STE 150
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-5711
Mailing Address - Country:US
Mailing Address - Phone:512-345-3595
Mailing Address - Fax:512-345-7618
Practice Address - Street 1:4700 SETON CENTER PKWY STE 150
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-5711
Practice Address - Country:US
Practice Address - Phone:512-345-3595
Practice Address - Fax:512-345-7618
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-31
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046010492152W00000X
CA12681152W00000X
TX6996TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1770677908Medicaid