Provider Demographics
NPI:1659485654
Name:HASTINGS, ROXANA JEAN (OD)
Entity Type:Individual
Prefix:MRS
First Name:ROXANA
Middle Name:JEAN
Last Name:HASTINGS
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 1:1387 SATTLER ROAD SUITE A
Mailing Address - Street 2:
Mailing Address - City:SATTLER
Mailing Address - State:TX
Mailing Address - Zip Code:78132
Mailing Address - Country:US
Mailing Address - Phone:830-964-3937
Mailing Address - Fax:928-341-0881
Practice Address - Street 1:1387 SATTLER ROAD SUITE A
Practice Address - Street 2:
Practice Address - City:SATTLER
Practice Address - State:TX
Practice Address - Zip Code:78132
Practice Address - Country:US
Practice Address - Phone:830-964-3937
Practice Address - Fax:928-341-0881
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1407152W00000X
HI504152W00000X
TX5299T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U63984Medicare UPIN
Z84974Medicare ID - Type Unspecified