Provider Demographics
NPI:1932677101
Name:HILDEBRAND, MATTHEW (OD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:
Last Name:HILDEBRAND
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 E INTERSTATE 20
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76018-1119
Mailing Address - Country:US
Mailing Address - Phone:817-784-0222
Mailing Address - Fax:817-417-0981
Practice Address - Street 1:350 E INTERSTATE 20
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76018-1119
Practice Address - Country:US
Practice Address - Phone:817-784-0222
Practice Address - Fax:817-417-0981
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-06
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9615T152W00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes152W00000XEye and Vision Services ProvidersOptometrist