Provider Demographics
NPI:1841418555
Name:MERLINO, BRIAN (OD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:
Last Name:MERLINO
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 1:12438 BRISTOL COMMONS CIR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33626-2409
Mailing Address - Country:US
Mailing Address - Phone:813-482-1241
Mailing Address - Fax:
Practice Address - Street 1:30715 US HIGHWAY 19 N
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684-4400
Practice Address - Country:US
Practice Address - Phone:727-785-8645
Practice Address - Fax:727-786-8258
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC3923152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL620968800Medicaid
FLU3563ZMedicare ID - Type Unspecified
FLV01842Medicare UPIN