Individual
MARK A. MATHEWS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
218 S. FRONT ST, FREMONT, OH 43420
(419) 332-4309
(419) 332-3834
Mailing address
218 S. FRONT ST., FREMONT, OH 43420
(419) 332-4309
(419) 332-3834
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
3680T871
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0545020
—
OH
01
—
410047929
MEDICARE RAILROAD
OH
Enumeration date
04/26/2006
Last updated
09/25/2015
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