Provider Demographics
NPI:1295172534
Name:MEDINA VISION CARE PLLC
Entity type:Organization
Organization Name:MEDINA VISION CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:ANA
Authorized Official - Middle Name:L
Authorized Official - Last Name:SALINAS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:956-682-2141
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:956-682-9484
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:956-682-9484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-28
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX323815Medicare PIN