Kostallas, Anthony

Kostallas, Anthony is an sole proprietor health care provider with primary practice located at 6325 Pacific Blvd Ste. 104, Huntington Park CA 90255-4100. He recently has 2 registered licenses in different health care specialties including Eye and Vision Services Providers / Optometrist, Eye and Vision Services Providers / Corneal and Contact Management. Eye and Vision Services Providers / Optometrist is his primary health care specialty. Kostallas, Anthony can be contacted via phone (323) 581-4466.

Contact Information

Primary practice address
6325 Pacific Blvd Ste. 104 Huntington Park CA 90255-4100
Phone: (323) 581-4466
Fax: (323) 587-8650
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Eye and Vision Services Providers / Optometrist 152W00000X 6482T California
Eye and Vision Services Providers / Corneal and Contact Management 152WC0802X 6482T California

Profile Details

NPI number 1588641898
LBN Legal business name Kostallas, Anthony
Credentials Doctor of Optometry (OD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Dec 28th, 2005
Last updated Jul 9th, 2007 - about 19 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1588641898 NPPES
California MEDICAID SD0064820

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