MEDICARE: DR. JAMES DANIEL KAASTRUP I OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	1371	WA

General Provider Information

NPI Number	:	1093998775
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES DANIEL KAASTRUP I OD

Provider Business Mailing Address
First Line	:	7811 77TH ST NE
Second Line	:
City	:	MARYSVILLE
State	:	WA
Zip	:	98270-7841
Country	:	US
Telephone Number	:	425-876-4322
Fax Number	:	360-653-2466

Provider Business Practice Location Address
First Line	:	4502 S STEELE ST
Second Line	:	SUITE 200
City	:	TACOMA
State	:	WA
Zip	:	98409-7242
Country	:	US
Telephone Number	:	253-471-8369
Fax Number	:	253-475-7767

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/17/2007
Last Update Date	:	12/17/2007

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