Individual
MISS LISA MARIA MODESTO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
10933 71ST RD, SUITE 2 C, FOREST HILLS, NY 11375-4867
(718) 261-3366
Mailing address
610 E 20TH ST APT 4E, APT. 4 E, NEW YORK, NY 10009-1403
(917) 843-9639
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
TUV007078
NY
Other
Enumeration date
08/18/2006
Last updated
02/27/2008
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