MEDICARE: DR. ROBERT E. BRILL O.D.

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	152W00000X	Optometrist	5246T	CA

General Provider Information

NPI Number	:	1427125939
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT E. BRILL O.D.

Provider Business Mailing Address
First Line	:	4100 W ALAMEDA AVE
Second Line	:
City	:	BURBANK
State	:	CA
Zip	:	91505-4195
Country	:	US
Telephone Number	:	818-841-1212
Fax Number	:	818-841-6768

Provider Business Practice Location Address
First Line	:	4100 W ALAMEDA AVE
Second Line	:
City	:	BURBANK
State	:	CA
Zip	:	91505-4195
Country	:	US
Telephone Number	:	818-841-1212
Fax Number	:	818-841-6768

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/29/2006
Last Update Date	:	10/10/2014

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