NPIMap

Organization Active NPI

James W Mattern OD, PLLC

  • Optometrist
  • Fairfax, VA
National Provider Identifier
1376288597
Registry record updated May 19, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
JAMES W MATTERN OD, PLLC
Practice address
3025 Hamaker CT Ste 101
Fairfax, VA 22031-2229
Phone
(703) 876-9630
Fax
(703) 876-0163
NPI assigned
May 2, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 19, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
James W Mattern, ODNPI 1104973205
Title
Owner/President
Phone
(703) 876-9630

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152W00000X Primary
Ophthalmology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207W00000X

Addresses

Primary practice location

3025 Hamaker CT Ste 101
Fairfax, VA 22031-2229

Mailing address

3025 Hamaker CT Ste 101
Fairfax, VA 22031-2229
Phone (703) 876-9630

Other names 1

  • Capital Eye Consultants Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL MDI Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20221017002317 DC Part B Supplier - Clinic/Group Practice 6800262833 Receives reassigned benefits from 7 practitioners
Practice locations: Fairfax, VA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1651449600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1652918400000",
    "number": "1376288597",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3025 HAMAKER CT STE 101",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220312229",
            "telephone_number": "703-876-9630",
            "fax_number": "703-876-0163"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3025 HAMAKER CT STE 101",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220312229",
            "telephone_number": "703-876-9630",
            "fax_number": "703-876-0163"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JAMES W MATTERN OD, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-05-02",
        "last_updated": "2022-05-19",
        "certification_date": "2022-05-19",
        "status": "A",
        "authorized_official_last_name": "MATTERN",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "703-876-9630",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "MDI",
            "affiliation": "N",
            "endpointDescription": "Application used for providing patient care",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "3025 Hamaker Ct Ste 101",
            "city": "Fairfax",
            "state": "VA",
            "country_code": "US",
            "postal_code": "220312229",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Capital Eye Consultants",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Capital Eye Consultants",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fairfax, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.