Provider Demographics
NPI:1366785545
Name:MATOS, ESTRELLA
Entity type:Individual
Prefix:
First Name:ESTRELLA
Middle Name:
Last Name:MATOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:930 S MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18504-2749
Mailing Address - Country:US
Mailing Address - Phone:570-909-9767
Mailing Address - Fax:570-909-9732
Practice Address - Street 1:930 S MAIN AVE
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18504-2749
Practice Address - Country:US
Practice Address - Phone:570-909-9767
Practice Address - Fax:570-909-9732
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-05
Last Update Date:2013-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician