MEDICARE: RAUL A. TREVINO OD PA

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

General Provider Information

NPI Number	:	1932246758
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RAUL A. TREVINO OD PA

Provider Business Mailing Address
First Line	:	2210 NW MILITARY HWY
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78213-1890
Country	:	US
Telephone Number	:	210-344-1400
Fax Number	:	210-342-2039

Provider Business Practice Location Address
First Line	:	2210 NW MILITARY HWY
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78213-1815
Country	:	US
Telephone Number	:	210-344-1400
Fax Number	:	210-342-2039

Authorized Official
Title or Position	:	CONSULTANT
Name	:	EUDE A OSSORIO
Credential	:	CONSULTANTS
Telephone Number	:	832-934-1166

Provider Enumeration Date	:	01/31/2007
Last Update Date	:	02/06/2019

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