Provider Demographics
NPI:1477505584
Name:TREJO, JUAN (OD)
Entity type:Individual
Prefix:DR
First Name:JUAN
Middle Name:
Last Name:TREJO
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1006 W WABASH AVE
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95501-2121
Mailing Address - Country:US
Mailing Address - Phone:707-444-2685
Mailing Address - Fax:
Practice Address - Street 1:1630 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93906-5102
Practice Address - Country:US
Practice Address - Phone:831-443-4422
Practice Address - Fax:831-443-4516
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2015-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11537 TPL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U91588Medicare UPIN