Individual
MATTHEW K TUCKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OPTICIAN
Contact information
Practice address
1802 BRAEBURN DR, SALEM, VA 24153-7357
(540) 772-3480
(540) 772-3779
Mailing address
1802 BRAEBURN DRIVE, SALEM, VA 24153-7357
(540) 772-3480
(540) 772-3779
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
1101003129
VA
Other
Enumeration date
10/14/2010
Last updated
10/14/2010
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