MEDICARE: ROBERT E. BRILL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332H00000X	Eyewear Supplier	5246T	CA

General Provider Information

NPI Number	:	1730344284
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROBERT E. BRILL

Provider Business Mailing Address
First Line	:	11307 VENTURA BLVD
Second Line	:
City	:	STUDIO CITY
State	:	CA
Zip	:	91604-3138
Country	:	US
Telephone Number	:	818-509-0828
Fax Number	:	818-509-1808

Provider Business Practice Location Address
First Line	:	11307 VENTURA BLVD
Second Line	:
City	:	STUDIO CITY
State	:	CA
Zip	:	91604-3138
Country	:	US
Telephone Number	:	818-509-0828
Fax Number	:	818-509-1808

Authorized Official
Title or Position	:	OWNER
Name	:	ROBERT E. BRILL
Credential	:
Telephone Number	:	818-509-0828

Provider Enumeration Date	:	07/24/2008
Last Update Date	:	07/24/2008

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