Individual
MARIEL JOSELIN MATA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
5832 BOAT CLUB RD, FORT WORTH, TX 76179-7773
(817) 237-7153
(817) 595-6540
Mailing address
8614 WESTWOOD CENTER DR FL 9, VIENNA, VA 22182-2442
(703) 847-8899
(571) 223-6780
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
11540
TX
Other
Enumeration date
07/26/2024
Last updated
09/23/2025
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