Provider Demographics
NPI:1316098924
Name:MATHIS, JAMES A (OD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:A
Last Name:MATHIS
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:3600 FAIRWAY CIR
Mailing Address - Street 2:
Mailing Address - City:CORNVILLE
Mailing Address - State:AZ
Mailing Address - Zip Code:86325-4960
Mailing Address - Country:US
Mailing Address - Phone:928-300-9059
Mailing Address - Fax:928-634-4532
Practice Address - Street 1:2003 E RODEO DR
Practice Address - Street 2:
Practice Address - City:COTTONWOOD
Practice Address - State:AZ
Practice Address - Zip Code:86326-5999
Practice Address - Country:US
Practice Address - Phone:928-634-4530
Practice Address - Fax:928-634-4532
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2013-11-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ1409152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ101092Medicare PIN
AZV02110Medicare UPIN