Provider Demographics
NPI:1851675524
Name:REGO, ROBERT EMMETT (OD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:EMMETT
Last Name:REGO
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 1:12190 LONGVIEW LAKE CIR
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34211-5000
Mailing Address - Country:US
Mailing Address - Phone:954-651-7228
Mailing Address - Fax:
Practice Address - Street 1:13140 S TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:OSPREY
Practice Address - State:FL
Practice Address - Zip Code:34229-3801
Practice Address - Country:US
Practice Address - Phone:941-248-0235
Practice Address - Fax:941-248-0245
Is Sole Proprietor?:No
Enumeration Date:2011-09-29
Last Update Date:2025-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC4660152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL126660000Medicaid
FLFS95VMedicare PIN