Provider Demographics
NPI:1881769008
Name:KASTL, JOHN D (OD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:D
Last Name:KASTL
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:4901 N KICKAPOO AVE
Mailing Address - Street 2:SUITE#1606
Mailing Address - City:SHAWNEE
Mailing Address - State:OK
Mailing Address - Zip Code:74804-1303
Mailing Address - Country:US
Mailing Address - Phone:405-273-5014
Mailing Address - Fax:405-273-5014
Practice Address - Street 1:4901 N KICKAPOO AVE
Practice Address - Street 2:SUITE#1606
Practice Address - City:SHAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74804-1303
Practice Address - Country:US
Practice Address - Phone:405-273-5014
Practice Address - Fax:405-273-5014
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OKOK936152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKOK936OtherSTATE LICENSE NUMBER