Provider Demographics
NPI:1235153404
Name:MATTHEWS, JOHN HAROLD (OD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:HAROLD
Last Name:MATTHEWS
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 1:725 CAMPBELLSVILLE BYP
Mailing Address - Street 2:
Mailing Address - City:CAMPBELLSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42718-8846
Mailing Address - Country:US
Mailing Address - Phone:270-465-3669
Mailing Address - Fax:270-789-0643
Practice Address - Street 1:725 CAMPBELLSVILLE BYP
Practice Address - Street 2:
Practice Address - City:CAMPBELLSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42718-8846
Practice Address - Country:US
Practice Address - Phone:270-274-4144
Practice Address - Fax:270-274-2176
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1518DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY001511979OtherHIGHMARK
KY22555OtherSPECTERA
KY000000340031OtherANTHEM
KY140639321615OtherHUMANA
KY77000594Medicaid
KYU88651Medicare UPIN
KY77000594Medicaid
KY22555OtherSPECTERA