Provider Demographics
NPI:1457335788
Name:MATTEI, JOSE A (OD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:A
Last Name:MATTEI
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:PLAZOLETA MORELL CAMPOS SUITE 4
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00732
Mailing Address - Country:US
Mailing Address - Phone:787-928-7070
Mailing Address - Fax:787-651-6002
Practice Address - Street 1:PLAZOLETA MORELL CAMPOS SUITE 4
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00732
Practice Address - Country:US
Practice Address - Phone:787-928-7070
Practice Address - Fax:787-651-6002
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-30
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR190152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR038172800Medicaid
V03651Medicare UPIN