Provider Demographics
NPI:1902897986
Name:MATHEWS, TARYN ANN (OD)
Entity Type:Individual
Prefix:DR
First Name:TARYN
Middle Name:ANN
Last Name:MATHEWS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5865
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79408-5865
Mailing Address - Country:US
Mailing Address - Phone:806-743-2898
Mailing Address - Fax:806-743-2787
Practice Address - Street 1:4505 82ND ST
Practice Address - Street 2:SUITE 5
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424-3215
Practice Address - Country:US
Practice Address - Phone:806-798-7244
Practice Address - Fax:806-798-3391
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4999TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMA006OtherTRIWEST
TX84366ZOtherHMO BLUE
NM64047OtherPRESBYTERIAN COMMERCIAL
TX80318QOtherBC/BS
NM64047Medicaid
TXB6084Medicaid
NMA006OtherTRIWEST
TXB6084Medicaid