MEDICARE: DAWN 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	152WC0802X	Corneal and Contact Management Optometrist	6448TG	TX
2	152W00000X	Optometrist	6448TG	TX

General Provider Information

NPI Number	:	1467849778
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAWN MATOCHA O.D.

Provider Business Mailing Address
First Line	:	1936 SW MILITARY DR
Second Line	:	SUITE A
City	:	SAN ANTONIO
State	:	TX
Zip	:	78221-1461
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1936 SW MILITARY DR
Second Line	:	SUITE A
City	:	SAN ANTONIO
State	:	TX
Zip	:	78221-1461
Country	:	US
Telephone Number	:	210-932-2092
Fax Number	:

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

Provider Enumeration Date	:	04/24/2015
Last Update Date	:	12/10/2024

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