Provider Demographics
NPI:1588775423
Name:MATTHEWS, DAVID JEFFREY (OD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:JEFFREY
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:PO BOX 50367
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29250-0367
Mailing Address - Country:US
Mailing Address - Phone:803-787-0107
Mailing Address - Fax:803-787-0109
Practice Address - Street 1:3928 ROSEWOOD DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29205-3536
Practice Address - Country:US
Practice Address - Phone:803-787-0107
Practice Address - Fax:803-787-0109
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1034152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC410035583OtherRAILROAD MEDICARE
0005811543OtherETNA / OWENS CORNING
SCD10343Medicaid
SCU64000Medicare UPIN
SC410035583OtherRAILROAD MEDICARE