Provider Demographics
NPI:1023847316
Name:MATA, MARIEL JOSELIN (OD)
Entity type:Individual
Prefix:
First Name:MARIEL
Middle Name:JOSELIN
Last Name:MATA
Suffix:
Gender:F
Credentials:OD
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Other - Credentials:
Mailing Address - Street 1:8614 WESTWOOD CENTER DR FL 9
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-2442
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:571-223-6780
Practice Address - Street 1:5832 BOAT CLUB RD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76179-7773
Practice Address - Country:US
Practice Address - Phone:817-237-7153
Practice Address - Fax:817-595-6540
Is Sole Proprietor?:No
Enumeration Date:2024-07-26
Last Update Date:2025-09-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TX11540152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist