Provider Demographics
NPI:1023274800
Name:RHODES, MATTHEW ALAN (OD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:ALAN
Last Name:RHODES
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 1:2149 E LA COSTA DR
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85298-9737
Mailing Address - Country:US
Mailing Address - Phone:713-248-7152
Mailing Address - Fax:
Practice Address - Street 1:1876 E SABIN DR BLDG A
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85222-6197
Practice Address - Country:US
Practice Address - Phone:713-248-7152
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-01
Last Update Date:2012-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1644152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist