Healthcare Provider Details

I. General information

NPI: 1376878009
Provider Name (Legal Business Name): CRISTIN MATTIONE O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2009
Last Update Date: 03/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16006 ASH WAY STE 101
LYNNWOOD WA
98087-6352
US

IV. Provider business mailing address

900 AURORA AVE N APT 406
SEATTLE WA
98109-4358
US

V. Phone/Fax

Practice location:
  • Phone: 425-787-5200
  • Fax:
Mailing address:
  • Phone: 913-909-9788
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License NumberOD 60285868
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: