Individual
DR. RUSSELL HALE MATTERN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
2700 POTOMAC MILLS CIR, SUITE 207, WOODBRIDGE, VA 22192-4625
(703) 490-5275
Mailing address
2700 POTOMAC MILLS CIR, SUITE 207, WOODBRIDGE, VA 22192-4625
(703) 490-5275
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
0601000964
VA
Other
Enumeration date
05/12/2010
Last updated
05/12/2010
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