Provider Demographics
NPI:1376535187
Name:KASTLER, TINA (OD)
Entity Type:Individual
Prefix:DR
First Name:TINA
Middle Name:
Last Name:KASTLER
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 1:12215 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:623-341-2449
Mailing Address - Fax:402-894-0597
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:602-942-4124
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-17
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02240152W00000X
NE1172152W00000X
AZOPT-001673152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0291120Medicaid
NE04362571600Medicaid
AZ47590Medicaid
IA0291120Medicaid
NEU89591Medicare UPIN