Provider Demographics
NPI:1659375483
Name:MATTHEWS, JOHN DAIL (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:DAIL
Last Name:MATTHEWS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1313 CAROLINA ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-6000
Mailing Address - Country:US
Mailing Address - Phone:336-272-2625
Mailing Address - Fax:336-275-7507
Practice Address - Street 1:1313 CAROLINA STREET
Practice Address - Street 2:SUITE 103
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401
Practice Address - Country:US
Practice Address - Phone:336-272-2625
Practice Address - Fax:336-275-7507
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA010132083207W00000X
NC28666207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC10599OtherOPTICARE
NC3954711Medicaid
NC4098004OtherAETNA
NC278835OtherMAMSI
NC742OtherPARTNERS PROVIDER #
VA180000348OtherVA MEDICARE PROVIDER #
NC54711OtherBCBS PROVIDER #
VA180025050OtherRR MEDICARE
VA006360033OtherVA MEDICAID PROVIDER #
VA035008OtherANTHEM BCBS PROVIDER #
NC46637OtherMEDCOST
NC4098004OtherAETNA
NC278835OtherMAMSI
NC300554775OtherTAX ID NUMBER
NC208570Medicare PIN
VA180000352Medicare PIN