Provider Demographics
NPI:1437192184
Name:HAN, MATTHEW (OD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:HAN
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 1:47010 COMMUNITY PLZ
Mailing Address - Street 2:STE 150
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20164-1889
Mailing Address - Country:US
Mailing Address - Phone:703-430-6381
Mailing Address - Fax:703-430-0292
Practice Address - Street 1:47010 COMMUNITY PLZ
Practice Address - Street 2:STE 150
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20164-1889
Practice Address - Country:US
Practice Address - Phone:703-430-6381
Practice Address - Fax:703-430-0292
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-13
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000387152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist