Provider Demographics
NPI:1477651529
Name:SANTANA-RESTO, LILLIAN ELISA (OD)
Entity Type:Individual
Prefix:
First Name:LILLIAN
Middle Name:ELISA
Last Name:SANTANA-RESTO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1065 SOUTHERN BLVD
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10459-2417
Mailing Address - Country:US
Mailing Address - Phone:718-589-2440
Mailing Address - Fax:
Practice Address - Street 1:274 W 125TH ST
Practice Address - Street 2:ALL EYES ON US, INC.
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10027-4410
Practice Address - Country:US
Practice Address - Phone:212-663-1511
Practice Address - Fax:212-663-1510
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2019-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUVOO4957152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY11510086OtherCAQH PROVIDER ID
NY02666535Medicaid
NY02666535Medicaid