Provider Demographics
NPI:1033687058
Name:VANRACHACK, MINA ANTHONY (OD)
Entity Type:Individual
Prefix:MR
First Name:MINA
Middle Name:ANTHONY
Last Name:VANRACHACK
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:9725 DATAPOINT DR STE 106
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-2385
Mailing Address - Country:US
Mailing Address - Phone:210-615-9358
Mailing Address - Fax:210-249-0209
Practice Address - Street 1:9725 DATAPOINT DR STE 106
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-2385
Practice Address - Country:US
Practice Address - Phone:210-615-9358
Practice Address - Fax:210-249-0209
Is Sole Proprietor?:No
Enumeration Date:2018-11-07
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9621T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist