Provider Demographics
NPI:1336359520
Name:R B MATOCHA OPTOMETRIST INC
Entity type:Organization
Organization Name:R B MATOCHA OPTOMETRIST INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAY
Authorized Official - Middle Name:B
Authorized Official - Last Name:MATOCHA
Authorized Official - Suffix:
Authorized Official - Credentials:O D
Authorized Official - Phone:409-762-2020
Mailing Address - Street 1:2115 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77550-4637
Mailing Address - Country:US
Mailing Address - Phone:409-762-2020
Mailing Address - Fax:409-765-6741
Practice Address - Street 1:2115 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77550-4637
Practice Address - Country:US
Practice Address - Phone:409-762-2020
Practice Address - Fax:409-765-6741
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2014-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2167T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0885270001Medicare NSC