Provider Demographics
NPI:1154381788
Name:MATHER, THOMAS R (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:R
Last Name:MATHER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:9565 HIGHWAY 78 BLDG 200
Mailing Address - Street 2:
Mailing Address - City:LADSON
Mailing Address - State:SC
Mailing Address - Zip Code:29456-4118
Mailing Address - Country:US
Mailing Address - Phone:843-553-2477
Mailing Address - Fax:843-553-2478
Practice Address - Street 1:9565 HIGHWAY 78 BLDG 200
Practice Address - Street 2:
Practice Address - City:LADSON
Practice Address - State:SC
Practice Address - Zip Code:29456-4118
Practice Address - Country:US
Practice Address - Phone:843-553-2477
Practice Address - Fax:843-553-2478
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2023-08-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
SC11970207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP2613Medicaid
SCC61230Medicare UPIN