Provider Demographics
NPI:1750432589
Name:BRILL, DAVID B (OD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:B
Last Name:BRILL
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 1:1551 MIDNIGHT PASS WAY
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33765-1819
Mailing Address - Country:US
Mailing Address - Phone:727-797-2547
Mailing Address - Fax:
Practice Address - Street 1:23106 US HIGHWAY 19 N
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33765-1849
Practice Address - Country:US
Practice Address - Phone:727-724-9480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 2163152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U11232Medicare UPIN
FL20118Medicare ID - Type Unspecified