Provider Demographics
NPI:1346286879
Name:DI MATTINA, ANDREW JAMES (OD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:JAMES
Last Name:DI MATTINA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 DORIS DR
Mailing Address - Street 2:
Mailing Address - City:HOOKSETT
Mailing Address - State:NH
Mailing Address - Zip Code:03106-2112
Mailing Address - Country:US
Mailing Address - Phone:603-340-2404
Mailing Address - Fax:
Practice Address - Street 1:262 MAIN DUNSTABLE RD
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03062-1941
Practice Address - Country:US
Practice Address - Phone:603-598-1620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2014-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0863152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY10112416OtherCDPHP
NYV09656Medicare UPIN
NYRB0747Medicare PIN
NY390512OtherMVP
NY7636841OtherAETNA
NY4702310001Medicare NSC
NY204480094OtherEXCELLUS BCBS