Basic Information
| Provider Information | |||||||||
| NPI: | 1003546912 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MATTOX | ||||||||
| FirstName: | SIERRA | ||||||||
| MiddleName: | MARIE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | OD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4227 RESERVOIR LN S | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322234028 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9042347317 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4788 HODGES BLVD | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322247222 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9049929991 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2022 | ||||||||
| LastUpdateDate: | 06/14/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/20/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 0006096 | FL | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.