Provider Demographics
NPI:1659707230
Name:DAVIS, MATTHEW JAMES (OD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:JAMES
Last Name:DAVIS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:750 IRIS LANE
Mailing Address - Street 2:P.O.BOX 446
Mailing Address - City:NEWTON
Mailing Address - State:NC
Mailing Address - Zip Code:28658-3343
Mailing Address - Country:US
Mailing Address - Phone:828-464-4136
Mailing Address - Fax:828-464-6243
Practice Address - Street 1:750 IRIS LANE
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:NC
Practice Address - Zip Code:28658-3343
Practice Address - Country:US
Practice Address - Phone:828-464-4136
Practice Address - Fax:828-464-6243
Is Sole Proprietor?:No
Enumeration Date:2013-09-16
Last Update Date:2018-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2323152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0937NOtherBCBS
NC0937NOtherBCBS