Provider Demographics
NPI:1699770883
Name:MORELLO, MATTHEW CHARLES (OD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:CHARLES
Last Name:MORELLO
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 WESTGREEN BLVD
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-2799
Mailing Address - Country:US
Mailing Address - Phone:281-392-3937
Mailing Address - Fax:281-392-8671
Practice Address - Street 1:750 WESTGREEN BLVD
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-2799
Practice Address - Country:US
Practice Address - Phone:281-392-3937
Practice Address - Fax:281-392-8671
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2015-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX05586TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX170315901Medicaid
TX8B8274Medicare ID - Type Unspecified
TX170315901Medicaid