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:
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Other - Credentials:
Mailing Address - Street 1:14855 BLANCO RD STE 210
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-7729
Mailing Address - Country:US
Mailing Address - Phone:210-479-0900
Mailing Address - Fax:210-479-0903
Practice Address - Street 1:14855 BLANCO RD STE 210
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-7729
Practice Address - Country:US
Practice Address - Phone:210-479-0900
Practice Address - Fax:210-479-0903
Is Sole Proprietor?:No
Enumeration Date:2008-08-05
Last Update Date:2023-09-07
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