Provider Demographics
NPI:1255712378
Name:TREVINO, COURTNEY MOTA (OD)
Entity type:Individual
Prefix:DR
First Name:COURTNEY
Middle Name:MOTA
Last Name:TREVINO
Suffix:
Gender:
Credentials:OD
Other - Prefix:DR
Other - First Name:COURTNEY
Other - Middle Name:ANN
Other - Last Name:MOTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:83B FAUNCE CORNER RD
Mailing Address - Street 2:
Mailing Address - City:NORTH DARTMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02747-1210
Mailing Address - Country:US
Mailing Address - Phone:508-997-6591
Mailing Address - Fax:508-994-9175
Practice Address - Street 1:83B FAUNCE CORNER RD
Practice Address - Street 2:
Practice Address - City:NORTH DARTMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02747
Practice Address - Country:US
Practice Address - Phone:508-997-6591
Practice Address - Fax:508-994-9175
Is Sole Proprietor?:No
Enumeration Date:2015-06-15
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIODTG00616152W00000X
MA5113152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI1255712378Medicaid