Michael Richard Kostura II, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

12316T Issued in CA

Practice address

21612 Plano Trabuco Rd Ste C
Trabuco Canyon, CA 92679-3488

Phone

(949) 459-5687

Fax

(949) 459-5690

NPI assigned

Feb 27, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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.

• Kostura Optometric Corp

  • Primary Care Clinic/Center
  • Trabuco Canyon, CA
  • NPI 1578181491
  Medicare reassignment Authorized official
• Ecs of Los Angeles I Optometry Corporation

  • Optometrist
  • Trabuco Canyon, CA
  • NPI 1356205652
  Medicare reassignment

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

{
    "created_epoch": "1172534400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1700913829",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21612 PLANO TRABUCO RD STE C",
            "city": "TRABUCO CANYON",
            "state": "CA",
            "postal_code": "926793488",
            "telephone_number": "949-459-5687",
            "fax_number": "949-459-5690"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21612 PLANO TRABUCO RD STE C",
            "city": "TRABUCO CANYON",
            "state": "CA",
            "postal_code": "926793488",
            "telephone_number": "949-459-5687",
            "fax_number": "949-459-5690"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOSTURA",
        "first_name": "MICHAEL",
        "middle_name": "RICHARD",
        "name_prefix": "Dr.",
        "name_suffix": "II",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-27",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "12316T",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jewelana Marie Kayanan
• Beth Ann Ketchmark-Ryan, PT
• Eva Khalili
• Bianca Kiefer
• Kostura Optometric Corp
• Sonia Kim Kostura, O.D.
• Connie Lac
• Casey Bich Le, AMFT
• Alyssa Leblanc
• Rayna Michelle Leland, PA-C

• Optometrist in Trabuco Canyon, CA
• Providers in Trabuco Canyon, CA by specialty
• Optometrist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.