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General NPI Number Information
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NPI Number | 1073645958
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Entity Type | Organization
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Legal Business Name | MEDINA VISION ASSOCIATES, PLLC
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Dates
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Enumeration Date | 03/09/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 109 22ND STREET
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City | HONDO
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State | TX
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Zip | 78861-2514
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Country | US
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Telephone | 830-741-8555
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Fax | 830-741-8557
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Provider Business Mailing Address
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Address Line | 109 22ND STREET
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City | HONDO
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State | TX
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Zip | 78861-2514
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Country | US
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Telephone | 830-741-8555
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Fax | 830-741-8557
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. NEIL MICHAEL HORNER
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Credential | O.D.
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Telephone | 830-741-8555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 4440T
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 5668TG
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License Number State | TX
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