Individual
DR. AUTUMN M MANTEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
14465 POTOMAC MILLS RD, WOODBRIDGE, VA 22192-6807
(703) 494-6184
(703) 499-9744
Mailing address
8614 WESTWOOD CENTER DR FL 9, VIENNA, VA 22182-2442
(703) 847-8899
(571) 223-6780
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
0618003387
VA
152W00000X
Optometrist
OD00003988
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1048492
—
WA
01
—
368024
WA LABOR & INDUSTRIES
WA
Enumeration date
08/02/2006
Last updated
04/18/2024
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