Provider Demographics
NPI:1104829654
Name:KANTOR, STEVEN HARRY (OD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:HARRY
Last Name:KANTOR
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5727 N 7TH ST
Mailing Address - Street 2:STE 105
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-5815
Mailing Address - Country:US
Mailing Address - Phone:602-265-8597
Mailing Address - Fax:602-265-6811
Practice Address - Street 1:5727 N 7TH ST
Practice Address - Street 2:STE 105
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-5815
Practice Address - Country:US
Practice Address - Phone:602-265-8597
Practice Address - Fax:602-265-6811
Is Sole Proprietor?:No
Enumeration Date:2005-05-28
Last Update Date:2008-04-29
Deactivation Date:2006-03-17
Deactivation Code:
Reactivation Date:2006-04-04
Provider Licenses
StateLicense IDTaxonomies
AZ0350152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ301705Medicaid
AZZ75998Medicare PIN
AZT41799Medicare UPIN