| NPI | 1952449837 |
|---|---|
| Former Name | PHILIP L MATTSON |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: AL S-A71-TA-632) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: WI 21400-875) |
| 152WV0400X Optometrist Vision Therapy (Licence: AL S-A71-TA-632) | |
| Enumeration Date | 2007-02-02 |
| Last Update Date | 2022-03-22 |