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General NPI Number Information
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NPI Number | 1629260500
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Entity Type | Organization
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Legal Business Name | GRILLO MONROE OPTOMETRY LLC
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Dates
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Enumeration Date | 08/14/2007
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Last Update Date | 10/17/2007
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Provider Practice Location Address
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Address Line | 945 E BRANDON BLVD
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City | BRANDON
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State | FL
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Zip | 33511-5500
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Country | US
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Telephone | 813-662-3937
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Fax | 813-662-5367
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Provider Business Mailing Address
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Address Line | 945 E BRANDON BLVD
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City | BRANDON
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State | FL
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Zip | 33511-5500
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Country | US
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Telephone | 813-662-3937
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Fax | 813-662-5367
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Authorized Official
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Title or Position | OWNER
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Name | DR. TERESA MARIA GRILLO
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Credential | OD
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Telephone | 813-662-3937
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPC3473
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License Number State | FL
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