MEDICARE: DR. JOHN DAIL MATTHEWS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	010132083	VA
2	207W00000X	Ophthalmology Physician	28666	NC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
6	180000348	OTHER	VA	VA MEDICARE PROVIDER #
8	180025050	OTHER	VA	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	10599	OTHER	NC	OPTICARE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	4098004	OTHER	NC	AETNA
4	278835	OTHER	NC	MAMSI
5	742	OTHER	NC	PARTNERS PROVIDER #
7	54711	OTHER	NC	BCBS PROVIDER #
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
10	035008	OTHER	VA	ANTHEM BCBS PROVIDER #
11	46637	OTHER	NC	MEDCOST

General Provider Information

NPI Number	:	1659375483
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN DAIL MATTHEWS MD

Provider Business Mailing Address
First Line	:	1313 CAROLINA ST
Second Line	:	SUITE 103
City	:	GREENSBORO
State	:	NC
Zip	:	27401-6000
Country	:	US
Telephone Number	:	336-272-2625
Fax Number	:	336-275-7507

Provider Business Practice Location Address
First Line	:	1313 CAROLINA STREET
Second Line	:	SUITE 103
City	:	GREENSBORO
State	:	NC
Zip	:	27401
Country	:	US
Telephone Number	:	336-272-2625
Fax Number	:	336-275-7507

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	09/20/2021

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Directions to “ DR. JOHN DAIL MATTHEWS MD” Practice Location

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