Provider Demographics
NPI:1073015160
Name:MATOBA, KIRK (OD)
Entity Type:Individual
Prefix:DR
First Name:KIRK
Middle Name:
Last Name:MATOBA
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 1:200 UNION BLVD STE 415
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80228-1832
Mailing Address - Country:US
Mailing Address - Phone:303-988-2777
Mailing Address - Fax:
Practice Address - Street 1:200 UNION BLVD STE 415
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80228-1832
Practice Address - Country:US
Practice Address - Phone:303-988-2777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-05
Last Update Date:2018-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOPT.0003370152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist