Provider Demographics
NPI:1811967821
Name:RESTIVO, VINCENT ANTHONY (MD)
Entity type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:ANTHONY
Last Name:RESTIVO
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Gender:M
Credentials:MD
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Mailing Address - Street 1:11901 W PARMER LN
Mailing Address - Street 2:STE 400
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-7655
Mailing Address - Country:US
Mailing Address - Phone:512-528-1144
Mailing Address - Fax:512-528-1143
Practice Address - Street 1:12171 W PARMER LN
Practice Address - Street 2:SUITE 201
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-7361
Practice Address - Country:US
Practice Address - Phone:512-528-1144
Practice Address - Fax:512-528-1143
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2016-05-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXK6970207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX143889702Medicaid
TX8S5180OtherBCBS OF TEXAS INDIVIDUAL #
TX143889702Medicaid
TXH36190Medicare UPIN