Healthcare Provider Details

I. General information

NPI: 1205116217
Provider Name (Legal Business Name): ANTHONY KASH SULLENGER O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2011
Last Update Date: 02/23/2026
Certification Date: 02/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15810 S 45TH ST STE 150
PHOENIX AZ
85048-7655
US

IV. Provider business mailing address

15810 S 45TH ST STE 150
PHOENIX AZ
85048-7655
US

V. Phone/Fax

Practice location:
  • Phone: 480-706-3060
  • Fax:
Mailing address:
  • Phone: 480-706-3060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT-001997
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number60240241
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: