Provider Demographics
NPI:1255887857
Name:DIGGORY, MATTHEW LAWRENCE (OD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:LAWRENCE
Last Name:DIGGORY
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 1:14726 RAMONA AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-5730
Mailing Address - Country:US
Mailing Address - Phone:626-305-9100
Mailing Address - Fax:626-305-0152
Practice Address - Street 1:1845 W REDLANDS BLVD STE 101
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-3125
Practice Address - Country:US
Practice Address - Phone:909-363-1450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-01
Last Update Date:2025-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT33521-TLG152W00000X
CA33521152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist