Provider Demographics
NPI:1790838969
Name:MEDINA, CLAUDIA M (OD)
Entity Type:Individual
Prefix:DR
First Name:CLAUDIA
Middle Name:M
Last Name:MEDINA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
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Mailing Address - Street 1:505 S BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78501-4903
Mailing Address - Country:US
Mailing Address - Phone:956-682-2141
Mailing Address - Fax:956-682-2142
Practice Address - Street 1:505 S BROADWAY ST
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501-4903
Practice Address - Country:US
Practice Address - Phone:956-682-2141
Practice Address - Fax:956-682-2142
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2016-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6617TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX169533001Medicaid
TXV01098Medicare UPIN
TXTXB140748Medicare PIN
TX169533001Medicaid