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General NPI Number Information
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NPI Number | 1255450771
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Entity Type | Individual
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Provider Name | JAY STUART MATTINGLY O.D.
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Gender | Male
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Dates
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Enumeration Date | 03/28/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 150 N INTERSTATE 35 E
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City | LANCASTER
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State | TX
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Zip | 75146-1844
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Country | US
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Telephone | 972-223-7220
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Fax |
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Provider Business Mailing Address
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Address Line | 2550 W FM 875
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City | MIDLOTHIAN
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State | TX
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Zip | 76065-5916
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Country | US
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Telephone | 972-775-1663
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | TX3661T
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License Number State | TX
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