Individual
DR. DARRYL D MATHEWSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
417 4TH ST, DEFIANCE, OH 43512-2605
(419) 782-9595
(419) 782-0876
Mailing address
417 4TH ST, DEFIANCE, OH 43512-2605
(419) 782-9595
(419) 782-0876
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
3876
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000133472
ANTHEM BLUE CROSS/BLUE SH
OH
01
—
0189490001
ADMINA-STAR FEDERAL
OH
05
—
0645092
—
OH
01
—
3876
GENERAL INSURANCE PIN
OH
Enumeration date
10/27/2005
Last updated
11/01/2007
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