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NPI Code Detail

MEDICARE: DR. NYDIA CAROL ROSILLO O.D.

MEDICARE: DR. NYDIA CAROL ROSILLO 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
1152W00000XOptometrist7299TGTX

General Provider Information

NPI Number : 1891951281
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. NYDIA CAROL ROSILLO O.D.
Provider Business Mailing Address
First Line : 22041 PELICAN EDGE
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78258-7849
Country : US
Telephone Number : 210-629-9928
Fax Number :
Provider Business Practice Location Address
First Line : 22832 US HIGHWAY 281 N
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78258-7430
Country : US
Telephone Number : 210-481-9634
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/05/2008
Last Update Date : 05/13/2025

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