Provider Demographics
NPI:1821277161
Name:MINNICK, VANESSA TRAN (OD)
Entity Type:Individual
Prefix:DR
First Name:VANESSA
Middle Name:TRAN
Last Name:MINNICK
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:VANESSA
Other - Middle Name:
Other - Last Name:TRAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:2800 E WHITESTONE BLVD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-7273
Mailing Address - Country:US
Mailing Address - Phone:512-260-9779
Mailing Address - Fax:512-260-3703
Practice Address - Street 1:2800 E WHITESTONE BLVD
Practice Address - Street 2:SUITE 210
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-7273
Practice Address - Country:US
Practice Address - Phone:512-260-9779
Practice Address - Fax:512-260-3703
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-02
Last Update Date:2011-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6111 TG152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8B2688Medicare PIN
TXU87166Medicare UPIN