Provider Demographics
NPI:1417641622
Name:MELARA, MARTA E (ABOC LIC # 177630)
Entity Type:Individual
Prefix:
First Name:MARTA
Middle Name:E
Last Name:MELARA
Suffix:
Gender:F
Credentials:ABOC LIC # 177630
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1313 FRY RD
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77449-3399
Mailing Address - Country:US
Mailing Address - Phone:281-579-6990
Mailing Address - Fax:281-579-6965
Practice Address - Street 1:1313 FRY RD
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77449-3399
Practice Address - Country:US
Practice Address - Phone:281-579-6990
Practice Address - Fax:281-579-6965
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-08
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX177630156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician