Provider Demographics
NPI:1891951281
Name:ROSILLO, NYDIA CAROL (OD)
Entity type:Individual
Prefix:DR
First Name:NYDIA
Middle Name:CAROL
Last Name:ROSILLO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22041 PELICAN EDGE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-7849
Mailing Address - Country:US
Mailing Address - Phone:210-629-9928
Mailing Address - Fax:
Practice Address - Street 1:22832 US HIGHWAY 281 N
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-7430
Practice Address - Country:US
Practice Address - Phone:210-481-9634
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-05
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7299TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F23684Medicare PIN