Provider Demographics
NPI:1770620924
Name:MATTHEWS, WILLIAM WAYNE (OD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:WAYNE
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 1:2883 DELANEY AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-5412
Mailing Address - Country:US
Mailing Address - Phone:407-219-4123
Mailing Address - Fax:407-210-7400
Practice Address - Street 1:1711 HOFFNER AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32809-3599
Practice Address - Country:US
Practice Address - Phone:407-855-4581
Practice Address - Fax:407-855-2435
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC000862152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL19868Medicare ID - Type Unspecified
FLT85193Medicare UPIN