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General NPI Number Information
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NPI Number | 1376288597
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Entity Type | Organization
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Legal Business Name | JAMES W MATTERN OD, PLLC
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Dates
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Enumeration Date | 05/02/2022
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Last Update Date | 05/19/2022
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Provider Practice Location Address
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Address Line | 3025 HAMAKER CT STE 101
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City | FAIRFAX
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State | VA
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Zip | 22031-2229
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Country | US
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Telephone | 703-876-9630
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Fax | 703-876-0163
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Provider Business Mailing Address
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Address Line | 3025 HAMAKER CT STE 101
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City | FAIRFAX
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State | VA
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Zip | 22031-2229
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Country | US
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Telephone | 703-876-9630
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Fax | 703-876-0163
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | JAMES W MATTERN
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Credential | OD
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Telephone | 703-876-9630
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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