Provider Demographics
NPI:1437836020
Name:MATTSON, JADA JOY (OD)
Entity Type:Individual
Prefix:
First Name:JADA
Middle Name:JOY
Last Name:MATTSON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2570 LAWRENCE ST APT 210
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80205-3865
Mailing Address - Country:US
Mailing Address - Phone:701-590-2978
Mailing Address - Fax:
Practice Address - Street 1:10520 EL DIENTE CT STE A
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80112-2656
Practice Address - Country:US
Practice Address - Phone:720-524-1001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-05
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOPT.0003949152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist