Individual
DR. ANTHONY MODESTO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
385 ROUTE 25A, SUITE 6, MILLER PLACE, NY 11764-2525
(631) 642-8400
(631) 642-8403
Mailing address
385 ROUTE 25A, SUITE 6, MILLER PLACE, NY 11764-2525
(631) 642-8400
(631) 642-8403
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
TUV00395-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00654848
—
NY
Enumeration date
11/01/2006
Last updated
07/08/2007
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