Provider Demographics
NPI:1972342368
Name:BARILLARO, SHAWN (OD)
Entity type:Individual
Prefix:
First Name:SHAWN
Middle Name:
Last Name:BARILLARO
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 1:3 SHORE LN
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MA
Mailing Address - Zip Code:01521-2425
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:891 WESTMINSTER ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-4020
Practice Address - Country:US
Practice Address - Phone:401-688-2301
Practice Address - Fax:401-274-4739
Is Sole Proprietor?:No
Enumeration Date:2024-05-23
Last Update Date:2025-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618003496152W00000X
390200000X
RIODTG00776152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program