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General NPI Number Information
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NPI Number | 1346286879
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Entity Type | Individual
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Provider Name | ANDREW JAMES DI MATTINA O.D.
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Gender | Male
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Dates
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Enumeration Date | 06/22/2006
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Last Update Date | 04/22/2014
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Provider Practice Location Address
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Address Line | 262 MAIN DUNSTABLE RD
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City | NASHUA
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State | NH
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Zip | 03062-1941
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Country | US
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Telephone | 603-598-1620
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Fax |
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Provider Business Mailing Address
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Address Line | 15 DORIS DR
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City | HOOKSETT
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State | NH
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Zip | 03106-2112
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Country | US
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Telephone | 603-340-2404
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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 | 0863
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License Number State | NH
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