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General NPI Number Information
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NPI Number | 1639069081
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Entity Type | Individual
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Provider Name | SHAWN MATSUMOTO OD
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Gender | Male
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Dates
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Enumeration Date | 07/08/2025
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Last Update Date | 08/19/2025
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Provider Practice Location Address
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Address Line | 2150 E PALM VALLEY BLVD STE 300
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City | ROUND ROCK
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State | TX
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Zip | 78665-1532
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Country | US
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Telephone | 512-817-0033
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Fax | 512-817-0077
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Provider Business Mailing Address
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Address Line | 11034 CROSSLAND DR
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City | AUSTIN
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State | TX
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Zip | 78726-1319
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 11366TG
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License Number State | TX
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