Provider Demographics
NPI:1851777031
Name:MATHEW, AMY (OD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:MATHEW
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:PHILIP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8714 LOHR VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-3906
Mailing Address - Country:US
Mailing Address - Phone:214-762-9672
Mailing Address - Fax:
Practice Address - Street 1:8714 LOHR VALLEY RD
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-3906
Practice Address - Country:US
Practice Address - Phone:214-762-9672
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-10
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8656T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist