Provider Demographics
NPI:1336117910
Name:KASTENBAUM, STEVEN M (OD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:M
Last Name:KASTENBAUM
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 1:2901 WILSHIRE BLVD
Mailing Address - Street 2:STE 100
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-4915
Mailing Address - Country:US
Mailing Address - Phone:310-315-1936
Mailing Address - Fax:
Practice Address - Street 1:2901 WILSHIRE BLVD
Practice Address - Street 2:STE 100
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-4915
Practice Address - Country:US
Practice Address - Phone:310-315-1936
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-09
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5708T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOP5708Medicare PIN