Provider Demographics
NPI:1558345751
Name:MATOBA, ESTHER NAOMI (OD)
Entity Type:Individual
Prefix:DR
First Name:ESTHER
Middle Name:NAOMI
Last Name:MATOBA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:E
Other - Middle Name:NAOMI
Other - Last Name:YANO-MATOBA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:200 UNION BLVD
Mailing Address - Street 2:SUITE 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:SUITE 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
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-01
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOPT1317152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO08013179Medicaid
COC42433Medicare PIN
COU06063Medicare UPIN
CO08013179Medicaid