NPI 1003134248

Russell Hale Mattern, OD

Practitioner Optometrist Woodbridge, VA

Practice location

Address: 2700 Potomac Mills Cir Suite 207, Woodbridge, VA 22192-4625
Phone: (703) 490-5275

Registered specialties

Optometrist Primary

Eye and Vision Services Providers Taxonomy 152W00000X Licence 0601000964 (VA)

Other Optometrist providers in Virginia →

Registry record

NPI: 1003134248
Entity type: Individual
Sex (as registered): Male
NPI issued: 12 May 2010
Record last updated: 12 May 2010

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.