Healthcare Provider Details

I. General information

NPI: 1427490192
Provider Name (Legal Business Name): MATTHEW PHILIP SCHUKAR O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2013
Last Update Date: 08/19/2022
Certification Date: 08/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

87 LOOP 150 W
BASTROP TX
78602-3930
US

IV. Provider business mailing address

87 LOOP 150 W
BASTROP TX
78602-3930
US

V. Phone/Fax

Practice location:
  • Phone: 512-314-1613
  • Fax: 512-314-1661
Mailing address:
  • Phone: 512-321-2106
  • Fax: 512-322-0273

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number8297-T
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: