Provider Demographics
NPI:1376288597
Name:JAMES W MATTERN OD, PLLC
Entity Type:Organization
Organization Name:JAMES W MATTERN OD, PLLC
Other - Org Name:CAPITAL EYE CONSULTANTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:W
Authorized Official - Last Name:MATTERN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:703-876-9630
Mailing Address - Street 1:3025 HAMAKER CT STE 101
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-2229
Mailing Address - Country:US
Mailing Address - Phone:703-876-9630
Mailing Address - Fax:703-876-0163
Practice Address - Street 1:3025 HAMAKER CT STE 101
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-2229
Practice Address - Country:US
Practice Address - Phone:703-876-9630
Practice Address - Fax:703-876-0163
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-02
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty