Provider Demographics
NPI:1528029543
Name:RAKICH, DAWN (OD)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:
Last Name:RAKICH
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:78213-1852
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:78213-1852
Practice Address - Country:US
Practice Address - Phone:210-340-3535
Practice Address - Fax:210-340-3581
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-29
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3383TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0176940001Medicare NSC
TX00E65CMedicare PIN
TXT15421Medicare UPIN