MEDICARE: DR. JUDY S. KASTL O.D.

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	2253	OK

General Provider Information

NPI Number	:	1760660989
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUDY S. KASTL O.D.

Provider Business Mailing Address
First Line	:	3505 W KENOSHA ST
Second Line	:
City	:	BROKEN ARROW
State	:	OK
Zip	:	74012-8948
Country	:	US
Telephone Number	:	918-872-6161
Fax Number	:

Provider Business Practice Location Address
First Line	:	3505 W KENOSHA ST
Second Line	:
City	:	BROKEN ARROW
State	:	OK
Zip	:	74012-8948
Country	:	US
Telephone Number	:	918-872-6161
Fax Number	:

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

Provider Enumeration Date	:	02/11/2008
Last Update Date	:	02/11/2008

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