Healthcare Provider Details

I. General information

NPI: 1538909056
Provider Name (Legal Business Name): KENDALL MATTONI OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2024
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3542 NAVARRE AVE
OREGON OH
43616-3430
US

IV. Provider business mailing address

8944 MANORE RD
GRAND RAPIDS OH
43522-9274
US

V. Phone/Fax

Practice location:
  • Phone: 419-693-4444
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT.007296
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: