| |
385 Route 25a Unit 6, Miller Place, NY 11764-2501 | |
(631) 642-8400 | |
(631) 642-8403 |
Full Name | |
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Type | Facility |
Speciality | Optometrist |
Location | 385 Route 25a Unit 6, Miller Place, New York |
Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1750573093 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
152W00000X | Optometrist | VUT003195 (New York) | Primary |
Provider Name | Anthony Modesto |
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Provider Type | Practitioner - Optometry |
Provider Identifiers | NPI Number: 1851478259 PECOS PAC ID: 3274522974 Enrollment ID: I20040507001345 |
Mailing Address | Practice Location Address |
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385 Route 25a Unit 6, Miller Place, NY 11764-2501 Ph: (631) 642-8400 | 385 Route 25a Unit 6, Miller Place, NY 11764-2501 Ph: (631) 642-8400 |
200 West Optics, Llc Optometrist Medicare: Not Enrolled in Medicare Practice Location: 385 Route 25a Unit 6, Miller Place, NY 11764 Phone: 631-342-8400 Fax: 631-642-8403 | |
Dr. Anthony Modesto, OD Optometrist Medicare: Accepting Medicare Assignments Practice Location: 385 Route 25a, Suite 6, Miller Place, NY 11764 Phone: 631-642-8400 Fax: 631-642-8403 |