Provider Demographics
NPI:1518133511
Name:MATVEEV, DIMITRI A (OD)
Entity Type:Individual
Prefix:DR
First Name:DIMITRI
Middle Name:A
Last Name:MATVEEV
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 1:651 HIGHWAY 28 BYP
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29624-3009
Mailing Address - Country:US
Mailing Address - Phone:864-556-2217
Mailing Address - Fax:
Practice Address - Street 1:651 HIGHWAY 28 BYP
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29624-3009
Practice Address - Country:US
Practice Address - Phone:864-556-2217
Practice Address - Fax:860-763-3856
Is Sole Proprietor?:No
Enumeration Date:2008-04-30
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2321152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist