Healthcare Provider Details

I. General information

NPI: 1548157548
Provider Name (Legal Business Name): GAVIN TRENT JAIME OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2025
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 N ALVERNON WAY STE 301
TUCSON AZ
85711-1848
US

IV. Provider business mailing address

707 N ALVERNON WAY STE 301
TUCSON AZ
85711-1848
US

V. Phone/Fax

Practice location:
  • Phone: 520-694-1460
  • Fax:
Mailing address:
  • Phone: 520-694-1460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT-002875
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: