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General NPI Number Information
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NPI Number | 1841525383
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Entity Type | Organization
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Legal Business Name | WILLIAM KASTERN, O.D., PH.D., LLC
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Dates
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Enumeration Date | 10/15/2009
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Last Update Date | 10/15/2009
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Provider Practice Location Address
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Address Line | 4822C VALLEY VIEW BLVD.
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City | ROANOKE
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State | VA
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Zip | 24012
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Country | US
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Telephone | 540-563-8279
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Fax | 540-563-5598
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Provider Business Mailing Address
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Address Line | 4822C VALLEY VIEW BLVD.
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City | ROANOKE
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State | VA
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Zip | 24012
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Country | US
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Telephone | 540-563-8279
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Fax | 540-563-5598
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | WILLIAM KASTERN
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Credential | O.D., PH.D.
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Telephone | 540-563-8279
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 0618001382
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License Number State | VA
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