Healthcare Provider Details

I. General information

NPI: 1184617367
Provider Name (Legal Business Name): DENNIS E MATHEWS OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 RIDGE LAKE BLVD
MEMPHIS TN
38120-9411
US

IV. Provider business mailing address

825 RIDGE LAKE BLVD
MEMPHIS TN
38120-9411
US

V. Phone/Fax

Practice location:
  • Phone: 901-685-2200
  • Fax: 901-820-2342
Mailing address:
  • Phone: 901-685-2200
  • Fax: 901-820-2342

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number675
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1000
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: