MEDICARE: MARLEN SARAS MATA OD

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	798	ND
2	152W00000X	Optometrist	10351T	TX

General Provider Information

NPI Number	:	1043887524
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARLEN SARAS MATA OD

Provider Business Mailing Address
First Line	:	925 COUNTY ROAD 3822
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78253-6862
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3107 TPC PKWY STE 101
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78259-2396
Country	:	US
Telephone Number	:	210-315-5559
Fax Number	:	210-988-2999

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

Provider Enumeration Date	:	06/04/2021
Last Update Date	:	04/14/2026

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Directions to “ MARLEN SARAS MATA OD” Practice Location

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