Individual provider Active NPI

Tina Kastler, O.D.

  • Optometrist
  • Glendale, AZ
National Provider Identifier
1376535187
Registry record updated May 19, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OPT-001673 Issued in AZ
Practice address
5845 W. Bell Rd
Glendale, AZ 85308
Phone
(602) 942-1475
Fax
(602) 942-4124
NPI assigned
Aug 17, 2005
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 19, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 02240 IA
Optometrist 152W00000X 1172 NE
Optometrist 152W00000X OPT-001673 AZ Primary

Addresses

Primary practice location

5845 W. Bell Rd
Glendale, AZ 85308

Mailing address

12215 W. Monte Lindo LN.
Sun City, AZ 85373
Phone (623) 341-2449

Other identifiers 3

IdentifierTypeStateIssuer
0291120MedicaidIA
04362571600MedicaidNE
47590MedicaidAZ

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
1172NEMDClinical Social Worker
OPT-001673AZMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Tina N. Kastler, OD PC Optometrist CurrentSince May 22, 2022 Accepting new patients
Legacy Eyecare, LLC Optometrist PastSince Aug 21, 2006 Accepting new patients

Locations

5845 W Bell Rd
Glendale, AZ 85308
Phone (602) 942-1475

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1124236800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1652918400000",
    "number": "1376535187",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12215 W. MONTE LINDO LN.",
            "city": "SUN CITY",
            "state": "AZ",
            "postal_code": "85373",
            "telephone_number": "623-341-2449",
            "fax_number": "402-894-0597"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5845 W. BELL RD",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "85308",
            "telephone_number": "602-942-1475",
            "fax_number": "602-942-4124"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KASTLER",
        "first_name": "TINA",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-08-17",
        "last_updated": "2022-05-19",
        "certification_date": "2022-05-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IA",
            "license": "02240",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NE",
            "license": "1172",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "AZ",
            "license": "OPT-001673",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0291120",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04362571600",
            "state": "NE"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "47590",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Glendale, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2022; 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.