Provider Demographics
NPI:1134643695
Name:RESTIVO, FRANK (OD)
Entity type:Individual
Prefix:DR
First Name:FRANK
Middle Name:
Last Name:RESTIVO
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2644 IMPERIAL VALLEY TRL
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60503-5669
Mailing Address - Country:US
Mailing Address - Phone:630-429-6009
Mailing Address - Fax:
Practice Address - Street 1:495 UNION ST STE 1082
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06706-1285
Practice Address - Country:US
Practice Address - Phone:203-591-8353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-26
Last Update Date:2017-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3047152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist