Mantel, Autumn M
Mantel, Autumn M is an individual health care provider with primary practice located at 14465 Potomac Mills Rd , Woodbridge VA 22192-6807. She recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as her primary health care specialty. Mantel, Autumn M can be contacted via phone (703) 494-6184.Contact Information
Primary practice address
14465 Potomac Mills Rd
Woodbridge VA 22192-6807
Phone: (703) 494-6184
Fax: (703) 499-9744
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Eye and Vision Services Providers / Optometrist | 152W00000X | OD00003988 | Washington |
| Eye and Vision Services Providers / Optometrist | 152W00000X | 0618003387 | Virginia |
Profile Details
| NPI number | 1740297829 |
|---|---|
| LBN Legal business name | Mantel, Autumn M |
| Credentials | Doctor of Optometry (OD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Aug 2nd, 2006 |
| Last updated | Apr 18th, 2024 - about last year |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1740297829 | NPPES |
| Washington | MEDICAID | 1048492 | |
| Washington | Other | 368024 |
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