Provider Demographics
NPI:1114117819
Name:MEDINA, ADDA O (OD)
Entity type:Individual
Prefix:MRS
First Name:ADDA
Middle Name:O
Last Name:MEDINA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:3128 FOREST LN STE 252
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75234-7764
Mailing Address - Country:US
Mailing Address - Phone:972-243-3373
Mailing Address - Fax:972-243-3373
Practice Address - Street 1:3128 FOREST LN STE 252
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75234-7764
Practice Address - Country:US
Practice Address - Phone:972-243-3373
Practice Address - Fax:972-243-3373
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-28
Last Update Date:2007-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician