Provider Demographics
NPI:1669434155
Name:MEDINA, ARTHUR A JR (OD)
Entity type:Individual
Prefix:
First Name:ARTHUR
Middle Name:A
Last Name:MEDINA
Suffix:JR
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2903 N SAINT MARYS ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78212-3532
Mailing Address - Country:US
Mailing Address - Phone:210-225-4141
Mailing Address - Fax:210-229-9400
Practice Address - Street 1:2903 N SAINT MARYS ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-3532
Practice Address - Country:US
Practice Address - Phone:210-225-4141
Practice Address - Fax:210-229-9400
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-03
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2120TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX093257601Medicaid
TXT14785Medicare UPIN
TX8F9214Medicare PIN