Provider Demographics
NPI:1073532099
Name:DR ARTHUR A. MEDINA OD P A
Entity Type:Organization
Organization Name:DR ARTHUR A. MEDINA OD P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:A
Authorized Official - Last Name:MEDINA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:210-225-4141
Mailing Address - Street 1:2903 N ST MARY'S
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78212-3500
Mailing Address - Country:US
Mailing Address - Phone:210-225-4141
Mailing Address - Fax:210-229-9400
Practice Address - Street 1:2903 N ST MARY'S
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-3500
Practice Address - Country:US
Practice Address - Phone:210-225-4141
Practice Address - Fax:210-229-9400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00Z858Medicare PIN
TXT14785Medicare UPIN