Provider Demographics
NPI:1619983731
Name:RESTO, LINDA (OD)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:
Last Name: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 1:152 CHANDLER LANE
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:NY
Mailing Address - Zip Code:12549
Mailing Address - Country:US
Mailing Address - Phone:845-457-4576
Mailing Address - Fax:
Practice Address - Street 1:1201 RTE 300
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550
Practice Address - Country:US
Practice Address - Phone:845-567-0174
Practice Address - Fax:845-567-3098
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV0049311152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01081410Medicaid
NY01081410Medicaid