Provider Demographics
NPI:1982647533
Name:MATTHEWS, JOHN PAUL (OD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:PAUL
Last Name:MATTHEWS
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 1:115 S ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76901-4101
Mailing Address - Country:US
Mailing Address - Phone:325-653-2383
Mailing Address - Fax:325-655-4783
Practice Address - Street 1:115 S ADAMS ST
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76901-4101
Practice Address - Country:US
Practice Address - Phone:325-653-2383
Practice Address - Fax:325-655-4783
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2739T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX093287301Medicaid
TX00E52JOtherBCBS
TX00E52JMedicare ID - Type Unspecified
TXT14647Medicare UPIN