Individual provider Active NPI

Steven Harry Kantor, O.D.

  • Optometrist
  • Phoenix, AZ
National Provider Identifier
1104829654
Registry record updated Apr 29, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
0350 Issued in AZ
Practice address
5727 N 7TH St
Ste 105
Phoenix, AZ 85014-5815
Phone
(602) 265-8597
Fax
(602) 265-6811
NPI assigned
May 28, 2005
Reactivated
Apr 4, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 29, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 0350 AZ Primary

Addresses

Primary practice location

5727 N 7TH St
Ste 105
Phoenix, AZ 85014-5815

Mailing address

5727 N 7TH St
Ste 105
Phoenix, AZ 85014-5815
Phone (602) 265-8597

Other identifiers 1

IdentifierTypeStateIssuer
301705MedicaidAZ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
0350AZMDAcupuncturist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1117238400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1209427200000",
    "number": "1104829654",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5727 N 7TH ST",
            "address_2": "STE 105",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850145815",
            "telephone_number": "602-265-8597",
            "fax_number": "602-265-6811"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5727 N 7TH ST",
            "address_2": "STE 105",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850145815",
            "telephone_number": "602-265-8597",
            "fax_number": "602-265-6811"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KANTOR",
        "first_name": "STEVEN",
        "middle_name": "HARRY",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-05-28",
        "last_updated": "2008-04-29",
        "deactivation_date": "2006-03-17",
        "reactivation_date": "2006-04-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "AZ",
            "license": "0350",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "301705",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.