Provider Demographics
NPI:1326240763
Name:MATHEWS & MATHEWS OPT INC
Entity Type:Organization
Organization Name:MATHEWS & MATHEWS OPT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RENU
Authorized Official - Middle Name:ELSA
Authorized Official - Last Name:MATHEW
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:210-223-1104
Mailing Address - Street 1:PO BOX 340399
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78234-0399
Mailing Address - Country:US
Mailing Address - Phone:210-223-1104
Mailing Address - Fax:210-223-3810
Practice Address - Street 1:2490 7TH ST
Practice Address - Street 2:BLDG 372
Practice Address - City:FORT SAM HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:78234-7613
Practice Address - Country:US
Practice Address - Phone:210-223-1104
Practice Address - Fax:210-223-3810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-05
Last Update Date:2013-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6942T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00Y456Medicare PIN