Provider Demographics
NPI:1992818017
Name:SANTORO, ELVIRA LINA (OD)
Entity type:Individual
Prefix:DR
First Name:ELVIRA
Middle Name:LINA
Last Name:SANTORO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:VIRA
Other - Middle Name:
Other - Last Name:SANTORO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:8614 WESTWOOD CENTER DR FL 9
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-2442
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:571-223-6780
Practice Address - Street 1:326 7TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-4105
Practice Address - Country:US
Practice Address - Phone:917-517-8907
Practice Address - Fax:718-832-6488
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005670152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02375542Medicaid
NY02375542Medicaid
U98392Medicare UPIN