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General NPI Number Information
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NPI Number | 1952891087
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Entity Type | Individual
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Provider Name | BASIL MATHEWS MD
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Gender | Male
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Dates
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Enumeration Date | 05/15/2018
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Last Update Date | 06/27/2023
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Provider Practice Location Address
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Address Line | 1008 NW 139TH STREET PKWY
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City | EDMOND
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State | OK
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Zip | 73013-9791
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Country | US
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Telephone | 888-323-3937
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Fax |
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Provider Business Mailing Address
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Address Line | 1008 NW 139TH STREET PKWY
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City | EDMOND
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State | OK
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Zip | 73013-9791
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Country | US
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Telephone | 888-323-3937
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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 | 207WX0009X
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Taxonomy Name | Glaucoma Specialist (Ophthalmology) Physician
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License Number | 33779
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License Number State | OK
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