Provider Demographics
NPI:1932246758
Name:RAUL A. TREVINO OD PA
Entity Type:Organization
Organization Name:RAUL A. TREVINO OD PA
Other - Org Name:VISION SOURCE-CASTLE HILLS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CONSULTANT
Authorized Official - Prefix:
Authorized Official - First Name:EUDE
Authorized Official - Middle Name:A
Authorized Official - Last Name:OSSORIO
Authorized Official - Suffix:
Authorized Official - Credentials:CONSULTANTS
Authorized Official - Phone:832-934-1166
Mailing Address - Street 1:2210 NW MILITARY HWY
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78213-1890
Mailing Address - Country:US
Mailing Address - Phone:210-344-1400
Mailing Address - Fax:210-342-2039
Practice Address - Street 1:2210 NW MILITARY HWY
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78213-1815
Practice Address - Country:US
Practice Address - Phone:210-344-1400
Practice Address - Fax:210-342-2039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX=========OtherTAX IDENTIFICATION NUMBER