MEDICARE: MARISSA MATHURA 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	7239TG	TX

General Provider Information

NPI Number	:	1609166586
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARISSA MATHURA O.D.

Provider Business Mailing Address
First Line	:	6060 NORTH FRY RD.
Second Line	:
City	:	KATY
State	:	TX
Zip	:	77449
Country	:	US
Telephone Number	:	281-815-5708
Fax Number	:	281-310-8773

Provider Business Practice Location Address
First Line	:	6060 NORTH FRY RD.
Second Line	:
City	:	KATY
State	:	TX
Zip	:	77449
Country	:	US
Telephone Number	:	281-815-5708
Fax Number	:	281-310-8773

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

Provider Enumeration Date	:	04/13/2011
Last Update Date	:	03/17/2026

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Directions to “ MARISSA MATHURA O.D.” Practice Location

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