MEDICARE: MEGAN MCCOLLOUGH MATOCHA O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	8655T	TX

General Provider Information

NPI Number	:	1700267572
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEGAN MCCOLLOUGH MATOCHA O.D.

Provider Business Mailing Address
First Line	:	18333 EGRET BAY BLVD STE 101
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77058-3200
Country	:	US
Telephone Number	:	281-488-5169
Fax Number	:	281-335-7854

Provider Business Practice Location Address
First Line	:	18333 EGRET BAY BLVD STE 101
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77058-3200
Country	:	US
Telephone Number	:	281-488-5169
Fax Number	:	281-335-7854

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/17/2015
Last Update Date	:	03/16/2021

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