Individual
KENNETH C MATHYS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
400 PARK ST, BELMONT, NC 28012-3368
(704) 295-3700
(704) 295-3707
Mailing address
6035 FAIRVIEW RD, CHARLOTTE, NC 28210-3256
(704) 295-3000
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
060667
GA
207W00000X
Ophthalmology Physician
Primary
2009-00712
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1444706
WELLCARE OF SC
SC
01
—
153UN
BCBSNC
NC
01
—
1645113
CIGNA
NC
05
—
929929330A
—
GA
05
—
NC3156
—
SC
01
—
NCY847A
NC MEDICARE
NC
Enumeration date
05/07/2007
Last updated
04/29/2021
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