Provider Demographics
NPI:1336209998
Name:ORSILLO, ROBERT (OD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:
Last Name:ORSILLO
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 8TH AVE W STE 101
Mailing Address - Street 2:
Mailing Address - City:PALMETTO
Mailing Address - State:FL
Mailing Address - Zip Code:34221-4737
Mailing Address - Country:US
Mailing Address - Phone:941-776-4000
Mailing Address - Fax:941-845-4963
Practice Address - Street 1:1312 MANATEE AVE E
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208-1358
Practice Address - Country:US
Practice Address - Phone:941-750-8797
Practice Address - Fax:941-750-8698
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC1684152W00000X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLNE589OtherMEDICARE
FL019945400Medicaid
FL19127OtherBLUE CROSS BLUE SHIELD
FLT84261Medicare UPIN
FL880032599OtherRAILROAD MEDICARE
FLAE012Medicare PIN