Individual provider Active NPI

Judy S. Kastl, O.D.

  • Optometrist
  • Broken Arrow, OK
National Provider Identifier
1760660989
Registry record updated Feb 11, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
2253 Issued in OK
Practice address
3505 W Kenosha St
Broken Arrow, OK 74012-8948
Phone
(918) 872-6161
NPI assigned
Feb 11, 2008
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 11, 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 2253 OK Primary

Addresses

Primary practice location

3505 W Kenosha St
Broken Arrow, OK 74012-8948

Mailing address

3505 W Kenosha St
Broken Arrow, OK 74012-8948
Phone (918) 872-6161

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK
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

Enrollment IDStateProvider typePAC IDDetails
I20090310000195 OK Practitioner - Optometry 3779649124 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Other, 1998
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

5401 E 71St St
Tulsa, OK 74136-6265
Phone (918) 728-2020

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2253OKMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Judy S Kastl OD LLC Optometrist CurrentSince Jan 7, 2009 Accepting new patients

Locations

5401 E 71st St
Ste 1
Tulsa, OK 74136
Phone (918) 728-2020

Organizations & group practices 1

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": "1202688000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1202688000000",
    "number": "1760660989",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3505 W KENOSHA ST",
            "city": "BROKEN ARROW",
            "state": "OK",
            "postal_code": "740128948",
            "telephone_number": "918-872-6161"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3505 W KENOSHA ST",
            "city": "BROKEN ARROW",
            "state": "OK",
            "postal_code": "740128948",
            "telephone_number": "918-872-6161"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KASTL",
        "first_name": "JUDY",
        "middle_name": "S.",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-02-11",
        "last_updated": "2008-02-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "OK",
            "license": "2253",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Broken Arrow, OK

Sources for this page

Verify at the official NPI Registry.