Provider Demographics
NPI:1518400571
Name:DRS MATOBA OPTOMETRISTS LLC
Entity Type:Organization
Organization Name:DRS MATOBA OPTOMETRISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MATOBA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:303-988-2777
Mailing Address - Street 1:200 UNION BLVD
Mailing Address - Street 2:STE 415
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80228-1830
Mailing Address - Country:US
Mailing Address - Phone:303-988-2777
Mailing Address - Fax:303-988-8855
Practice Address - Street 1:200 UNION BLVD
Practice Address - Street 2:STE 415
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80228-1830
Practice Address - Country:US
Practice Address - Phone:303-988-2777
Practice Address - Fax:303-988-8855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-23
Last Update Date:2016-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty