Provider Demographics
NPI:1164316824
Name:HOMETOWN PRIMARY OPTOMETRY PLLC
Entity type:Organization
Organization Name:HOMETOWN PRIMARY OPTOMETRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:G
Authorized Official - Last Name:MATTISON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:518-584-2620
Mailing Address - Street 1:15 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:NY
Mailing Address - Zip Code:12816-1168
Mailing Address - Country:US
Mailing Address - Phone:518-677-5422
Mailing Address - Fax:518-677-5134
Practice Address - Street 1:15 W MAIN ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:NY
Practice Address - Zip Code:12816-1168
Practice Address - Country:US
Practice Address - Phone:518-677-5422
Practice Address - Fax:518-677-5134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-06
Last Update Date:2025-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty