MEDICARE: DR. MARK JOSEPH TREVINO M.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	207W00000X	Ophthalmology Physician	P5307	TX

General Provider Information

NPI Number	:	1164650735
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK JOSEPH TREVINO M.D.

Provider Business Mailing Address
First Line	:	414 NAVARRO ST STE 400
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78205-2505
Country	:	US
Telephone Number	:	210-223-5561
Fax Number	:

Provider Business Practice Location Address
First Line	:	1048 E BLANCO RD
Second Line	:
City	:	BOERNE
State	:	TX
Zip	:	78006-1800
Country	:	US
Telephone Number	:	210-223-5561
Fax Number	:	210-223-5093

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

Provider Enumeration Date	:	06/23/2009
Last Update Date	:	05/13/2026

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