Healthcare Provider Details

I. General information

NPI: 1932246758
Provider Name (Legal Business Name): RAUL A. TREVINO OD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 02/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2210 NW MILITARY HWY
SAN ANTONIO TX
78213-1815
US

IV. Provider business mailing address

2210 NW MILITARY HWY
SAN ANTONIO TX
78213-1890
US

V. Phone/Fax

Practice location:
  • Phone: 210-344-1400
  • Fax: 210-342-2039
Mailing address:
  • Phone: 210-344-1400
  • Fax: 210-342-2039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: EUDE A OSSORIO
Title or Position: CONSULTANT
Credential: CONSULTANTS
Phone: 832-934-1166