Provider Demographics
NPI:1386493153
Name:TREVINO, NATALIE ANYSA (OD)
Entity type:Individual
Prefix:DR
First Name:NATALIE
Middle Name:ANYSA
Last Name:TREVINO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5488 S PADRE ISLAND DR STE 2042
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-4122
Mailing Address - Country:US
Mailing Address - Phone:361-994-0310
Mailing Address - Fax:361-257-1314
Practice Address - Street 1:5488 S PADRE ISLAND DR STE 2042
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-4122
Practice Address - Country:US
Practice Address - Phone:361-994-0310
Practice Address - Fax:361-257-1314
Is Sole Proprietor?:No
Enumeration Date:2024-05-15
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX390200000X
TX11158152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program