Provider Demographics
NPI:1730532144
Name:CASTANS, KYLIE (OD)
Entity type:Individual
Prefix:
First Name:KYLIE
Middle Name:
Last Name:CASTANS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1876 PITCHFORK RD
Mailing Address - Street 2:
Mailing Address - City:HARTSEL
Mailing Address - State:CO
Mailing Address - Zip Code:80449-8601
Mailing Address - Country:US
Mailing Address - Phone:847-456-7421
Mailing Address - Fax:
Practice Address - Street 1:1471 S HAVANA ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-4013
Practice Address - Country:US
Practice Address - Phone:303-671-9615
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-20
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2144152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ2144OtherARIZONA LICENSE NUMBER
COOPT.0003449OtherCOLORADO LICENSE NUMBER