Healthcare Provider Details

I. General information

NPI: 1336209998
Provider Name (Legal Business Name): ROBERT ORSILLO OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 08/10/2022
Certification Date: 08/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1312 MANATEE AVE E
BRADENTON FL
34208-1358
US

IV. Provider business mailing address

700 8TH AVE W STE 101
PALMETTO FL
34221-4737
US

V. Phone/Fax

Practice location:
  • Phone: 941-750-8797
  • Fax: 941-750-8698
Mailing address:
  • Phone: 941-776-4000
  • Fax: 941-845-4963

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPC1684
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: