Individual
DENNIS E MATHEWS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
825 RIDGE LAKE BLVD, MEMPHIS, TN 38120-9411
(901) 685-2200
(901) 820-2342
Mailing address
825 RIDGE LAKE BLVD, MEMPHIS, TN 38120-9411
(901) 685-2200
(901) 820-2342
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1000
TN
152W00000X
Optometrist
675
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00087009
—
MS
01
—
1000
OD LICENSE
TN
05
—
111234722
—
AR
01
—
3124319
BCBSTN
TN
05
—
316826809
—
MO
05
—
3595763
—
TN
01
—
410022830
RR MEDICARE
TN
01
—
675
OD LICENSE
MS
01
—
P01120062
RR MEDICARE
MS
Enumeration date
08/24/2005
Last updated
03/07/2023
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