Provider Demographics
NPI:1023229556
Name:STEVEN C. MATHER, O. D., P. C.
Entity type:Organization
Organization Name:STEVEN C. MATHER, O. D., P. C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:MATHER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:765-742-1955
Mailing Address - Street 1:1401 UNION ST
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47904-2059
Mailing Address - Country:US
Mailing Address - Phone:765-742-1955
Mailing Address - Fax:765-742-2020
Practice Address - Street 1:1401 UNION ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47904-2059
Practice Address - Country:US
Practice Address - Phone:765-742-1955
Practice Address - Fax:765-742-2020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-25
Last Update Date:2018-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN56000241A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN141070Medicare ID - Type Unspecified
INT35049Medicare UPIN