Provider Demographics
NPI:1285700534
Name:TINA N. KASTLER, OD PC
Entity type:Organization
Organization Name:TINA N. KASTLER, OD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TINA
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:KASTLER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:623-341-2449
Mailing Address - Street 1:12215 W MONTE LINDO LN
Mailing Address - Street 2:
Mailing Address - City:SUN CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:85373
Mailing Address - Country:US
Mailing Address - Phone:623-341-2443
Mailing Address - Fax:
Practice Address - Street 1:5845 W. BELL RD
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308
Practice Address - Country:US
Practice Address - Phone:602-942-1475
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0291120Medicaid
I10281Medicare ID - Type Unspecified