Provider Demographics
NPI:1932794898
Name:KASTNER, ZACHARY (ABO-AC)
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:
Last Name:KASTNER
Suffix:
Gender:M
Credentials:ABO-AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5150 N PORT WASHINGTON RD STE 250
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53217-5400
Mailing Address - Country:US
Mailing Address - Phone:414-332-1290
Mailing Address - Fax:414-800-6009
Practice Address - Street 1:5150 N PORT WASHINGTON RD STE 250
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:WI
Practice Address - Zip Code:53217-5400
Practice Address - Country:US
Practice Address - Phone:414-332-1290
Practice Address - Fax:414-800-6009
Is Sole Proprietor?:No
Enumeration Date:2021-03-03
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
224849156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician