Provider Demographics
NPI:1629225230
Name:ALFREDO TREVINO, JR., M.D., P.A.
Entity Type:Organization
Organization Name:ALFREDO TREVINO, JR., M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALFREDO
Authorized Official - Middle Name:
Authorized Official - Last Name:TREVINO
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:956-724-7179
Mailing Address - Street 1:1006 E HILLSIDE RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-3287
Mailing Address - Country:US
Mailing Address - Phone:956-724-7179
Mailing Address - Fax:956-725-2402
Practice Address - Street 1:1006 E HILLSIDE RD
Practice Address - Street 2:SUITE 1
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-3287
Practice Address - Country:US
Practice Address - Phone:956-724-7179
Practice Address - Fax:956-725-2402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-26
Last Update Date:2009-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6763TG152W00000X
TXD7341207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty