Healthcare Provider Details

I. General information

NPI: 1699128801
Provider Name (Legal Business Name): ANTHONY SESTO O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2016
Last Update Date: 09/13/2022
Certification Date: 09/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23620 HARPER AVE
SAINT CLAIR SHORES MI
48080-1448
US

IV. Provider business mailing address

23620 HARPER AVE
SAINT CLAIR SHORES MI
48080-1448
US

V. Phone/Fax

Practice location:
  • Phone: 586-775-6733
  • Fax: 586-775-0397
Mailing address:
  • Phone: 586-775-6733
  • Fax: 586-775-0397

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4901004977
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: