Provider Demographics
NPI:1750055059
Name:MATHEW, ASHITHA ELIZABETH (OD)
Entity Type:Individual
Prefix:
First Name:ASHITHA
Middle Name:ELIZABETH
Last Name:MATHEW
Suffix:
Gender:F
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:PO BOX 4615
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77210-4615
Mailing Address - Country:US
Mailing Address - Phone:713-275-2457
Mailing Address - Fax:
Practice Address - Street 1:1601 HIGHWAY 59 LOOP N STE 100
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:TX
Practice Address - Zip Code:77351-6687
Practice Address - Country:US
Practice Address - Phone:936-327-3937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-02
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10228T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist