Provider Demographics
NPI:1700267572
Name:MATOCHA, MEGAN MCCOLLOUGH (OD)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:MCCOLLOUGH
Last Name:MATOCHA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:18333 EGRET BAY BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77058-3200
Mailing Address - Country:US
Mailing Address - Phone:281-488-5169
Mailing Address - Fax:281-335-7854
Practice Address - Street 1:18333 EGRET BAY BLVD STE 101
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-3200
Practice Address - Country:US
Practice Address - Phone:281-488-5169
Practice Address - Fax:281-335-7854
Is Sole Proprietor?:No
Enumeration Date:2015-06-17
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8655T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist