Russell Hale Mattern OD

NPI 1003134248 - Optometrist - 152W00000X

NPI Details
NPI 1003134248
Gender Male
Enumeration Date 05/12/2010
Last Updated 05/12/2010
Entity Type Individual
Active Over 6 years ago
Practice Location
2700 POTOMAC MILLS CIR
SUITE 207
WOODBRIDGE VA, 22192-4625, US
Phone (703) 490-5275
Fax
Business Location
2700 POTOMAC MILLS CIR
SUITE 207
WOODBRIDGE VA, 22192-4625, US
Phone (703) 490-5275
Fax
Toxanomy
Taxonomy Code 152W00000X
License State Virginia
License Number 0601000964
Remove 1003134248 NPI Number
 

According to our database, Dr. Russell Hale Mattern OD NPI is 1003134248, taxonomy code is 152W00000X and license number is 0601000964, license state is located at Virginia. Russell Hale Mattern OD physically located at 2700 Potomac Mills Cir, Woodbridge VA, 22192-4625. NPI Number Russell Hale Mattern OD has the Individual type.

Sponsored links

1003134248 NPI number is provided on an as is basis without warranty of any kind. 1003134248 is maintained by the National Plan & Provider Enumeration System. The contents of Russell Hale Mattern OD are for informational purposes only.