Healthcare Provider Details

I. General information

NPI: 1467849778
Provider Name (Legal Business Name): DAWN MATOCHA O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2015
Last Update Date: 12/10/2024
Certification Date: 12/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1936 SW MILITARY DR SUITE A
SAN ANTONIO TX
78221-1461
US

IV. Provider business mailing address

1936 SW MILITARY DR SUITE A
SAN ANTONIO TX
78221-1461
US

V. Phone/Fax

Practice location:
  • Phone: 210-932-2092
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number6448TG
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number6448TG
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: