Provider Demographics
NPI:1346266749
Name:KASTNER, JAISY J (OD)
Entity Type:Individual
Prefix:DR
First Name:JAISY
Middle Name:J
Last Name:KASTNER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:373 MIDSTREAM DR
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:TX
Mailing Address - Zip Code:75182-3244
Mailing Address - Country:US
Mailing Address - Phone:314-322-4155
Mailing Address - Fax:
Practice Address - Street 1:1629 N TOWN EAST BLVD
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-4105
Practice Address - Country:US
Practice Address - Phone:972-686-6000
Practice Address - Fax:972-686-6111
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2020-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5909T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOU86881Medicare UPIN