=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295988251
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JUDY S KASTL OD LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/03/2008
-----------------------------------------------------
Last Update Date | 06/16/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5401 E 71ST ST SUITE ONE
-----------------------------------------------------
City | TULSA
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74136-6265
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-728-2020
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5401 E 71ST ST SUITE ONE
-----------------------------------------------------
City | TULSA
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74136-6265
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-728-2020
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OPTOMETRIST
-----------------------------------------------------
Name | DR. JUDY S. KASTL
-----------------------------------------------------
Credential | O.D.
-----------------------------------------------------
Telephone | 918-728-2020
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 2253
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------