Provider Demographics
NPI:1427490192
Name:SCHUKAR, MATTHEW PHILIP (OD)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:PHILIP
Last Name:SCHUKAR
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 1:87 LOOP 150 W
Mailing Address - Street 2:
Mailing Address - City:BASTROP
Mailing Address - State:TX
Mailing Address - Zip Code:78602-3930
Mailing Address - Country:US
Mailing Address - Phone:512-321-2106
Mailing Address - Fax:512-322-0273
Practice Address - Street 1:87 LOOP 150 W
Practice Address - Street 2:
Practice Address - City:BASTROP
Practice Address - State:TX
Practice Address - Zip Code:78602-3930
Practice Address - Country:US
Practice Address - Phone:512-314-1613
Practice Address - Fax:512-314-1661
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-23
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8297-T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist