Provider Demographics
NPI:1508207101
Name:MATTHEWS, W. TWELVIS T (OD)
Entity Type:Individual
Prefix:DR
First Name:W. TWELVIS
Middle Name:T
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 1:12229 BRANSTON DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78753-6864
Mailing Address - Country:US
Mailing Address - Phone:512-924-6297
Mailing Address - Fax:
Practice Address - Street 1:12229 BRANSTON DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78753-6864
Practice Address - Country:US
Practice Address - Phone:512-924-6297
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-11
Last Update Date:2018-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT002919152W00000X
TX8266T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist