Provider Demographics
NPI:1629047923
Name:MATHER, STEVEN CHARLES (OD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:CHARLES
Last Name:MATHER
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 1:1401 UNION ST
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47904-2059
Mailing Address - Country:US
Mailing Address - Phone:765-742-1955
Mailing Address - Fax:765-742-2020
Practice Address - Street 1:1401 UNION ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47904-2059
Practice Address - Country:US
Practice Address - Phone:765-742-1955
Practice Address - Fax:765-742-2020
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2018-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18001998B152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
141070Medicare ID - Type Unspecified
IN141070Medicare PIN
INU82518Medicare UPIN
IN0377350001Medicare NSC