Provider Demographics
NPI:1922671254
Name:MATHEW, ROSHINY ELSY (OD)
Entity Type:Individual
Prefix:DR
First Name:ROSHINY
Middle Name:ELSY
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 1:5144 E CRESCENT DR
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92807-3629
Mailing Address - Country:US
Mailing Address - Phone:714-457-0165
Mailing Address - Fax:
Practice Address - Street 1:5144 E CRESCENT DR
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92807-3629
Practice Address - Country:US
Practice Address - Phone:714-457-0165
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-23
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34846152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist