MEDICARE: ARTHUR A MEDINA JR. O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	2120TG	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1669434155
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ARTHUR A MEDINA JR. O.D.

Provider Business Mailing Address
First Line	:	2903 N SAINT MARYS ST
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78212-3532
Country	:	US
Telephone Number	:	210-225-4141
Fax Number	:	210-229-9400

Provider Business Practice Location Address
First Line	:	2903 N SAINT MARYS ST
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78212-3532
Country	:	US
Telephone Number	:	210-225-4141
Fax Number	:	210-229-9400

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/03/2006
Last Update Date	:	01/07/2015

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