Provider Demographics
NPI:1073533535
Name:DAWN M RAKICH OD
Entity Type:Organization
Organization Name:DAWN M RAKICH OD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:M
Authorized Official - Last Name:RAKICH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:210-340-3535
Mailing Address - Street 1:2267 NW MILITARY HWY
Mailing Address - Street 2:STE 106
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78213-1846
Mailing Address - Country:US
Mailing Address - Phone:210-340-3535
Mailing Address - Fax:210-340-3581
Practice Address - Street 1:2267 NW MILITARY HWY
Practice Address - Street 2:STE 106
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78213-1846
Practice Address - Country:US
Practice Address - Phone:210-340-3535
Practice Address - Fax:210-340-3581
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXT15421Medicare UPIN
TX00E65CMedicare PIN
TX0176940001Medicare NSC