Provider Demographics
NPI:1235741661
Name:MATHEW, DIANE (OD)
Entity Type:Individual
Prefix:DR
First Name:DIANE
Middle Name:
Last Name:MATHEW
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:DIANE
Other - Middle Name:A
Other - Last Name:MATHEW
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:2349A CENTRAL PARK AVE
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10710-1215
Mailing Address - Country:US
Mailing Address - Phone:914-620-0177
Mailing Address - Fax:
Practice Address - Street 1:2349A CENTRAL PARK AVE
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10710-1215
Practice Address - Country:US
Practice Address - Phone:914-620-0177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-18
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009233152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist