Provider Demographics
NPI:1902069834
Name:MASTRINE, MATTHEW (OD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:MASTRINE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 FOREST DR
Mailing Address - Street 2:
Mailing Address - City:EBENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15931-1703
Mailing Address - Country:US
Mailing Address - Phone:814-472-8000
Mailing Address - Fax:814-472-5778
Practice Address - Street 1:415 FOREST DR
Practice Address - Street 2:
Practice Address - City:EBENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15931-1703
Practice Address - Country:US
Practice Address - Phone:814-472-8000
Practice Address - Fax:814-472-5778
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-10
Last Update Date:2016-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG002073152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist