Provider Demographics
NPI:1811013774
Name:MATINI, ALI R (OD)
Entity type:Individual
Prefix:
First Name:ALI
Middle Name:R
Last Name:MATINI
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 1:1307 WISCONSIN AVE NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20007-3311
Mailing Address - Country:US
Mailing Address - Phone:202-744-7173
Mailing Address - Fax:202-333-6006
Practice Address - Street 1:1307 WISCONSIN AVE NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20007-3311
Practice Address - Country:US
Practice Address - Phone:202-744-7173
Practice Address - Fax:202-333-6006
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCOP759152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist