Provider Demographics
NPI:1558706978
Name:PASTOR, MATTHEW (LDO)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:PASTOR
Suffix:
Gender:M
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20201 N SCOTTSDALE HEALTHCARE DR STE 220
Mailing Address - Street 2:SUITE 220
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-4137
Mailing Address - Country:US
Mailing Address - Phone:480-696-4254
Mailing Address - Fax:
Practice Address - Street 1:20201 N SCOTTSDALE HEALTHCARE DR STE 220
Practice Address - Street 2:SUITE 220
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-4137
Practice Address - Country:US
Practice Address - Phone:480-696-4254
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-30
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2687I156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician