Provider Demographics
NPI:1922085513
Name:EVANS, MATTHEW E (OD)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:E
Last Name:EVANS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3829 UNION ST
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47905-4454
Mailing Address - Country:US
Mailing Address - Phone:765-447-4951
Mailing Address - Fax:765-447-4834
Practice Address - Street 1:3829 UNION ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-4454
Practice Address - Country:US
Practice Address - Phone:765-447-4951
Practice Address - Fax:765-447-4834
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002813152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist