Provider Demographics
NPI:1104095272
Name:BRUCE KASTNER, OD
Entity type:Organization
Organization Name:BRUCE KASTNER, OD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:KASTNER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:732-283-0682
Mailing Address - Street 1:6 DUNDEE AVE
Mailing Address - Street 2:
Mailing Address - City:ISELIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08830-2119
Mailing Address - Country:US
Mailing Address - Phone:732-283-0682
Mailing Address - Fax:
Practice Address - Street 1:6 DUNDEE AVE
Practice Address - Street 2:
Practice Address - City:ISELIN
Practice Address - State:NJ
Practice Address - Zip Code:08830-2119
Practice Address - Country:US
Practice Address - Phone:732-283-0682
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-22
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00496400332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1654101Medicaid
NJ4707400001Medicare NSC
NJK605967Medicare UPIN