Kostura Optometric Corp | |
21612 Plano Trabuco Rd Ste C Trabuco Canyon CA 92679-3488 | |
(949) 459-5687 | |
(949) 459-5690 |
Full Name | Kostura Optometric Corp |
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Speciality | Clinic/Center |
Location | 21612 Plano Trabuco Rd Ste C, Trabuco Canyon, California |
Authorized Official Name and Position | Michael R Kostura (PRESIDENT) |
Authorized Official Contact | 9492029935 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Kostura Optometric Corp 21612 Plano Trabuco Rd Ste C Trabuco Canyon CA 92679-3488 Ph: (949) 459-5687 | Kostura Optometric Corp 21612 Plano Trabuco Rd Ste C Trabuco Canyon CA 92679-3488 Ph: (949) 459-5687 |
NPI Number | 1578181491 |
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Provider Enumeration Date | 07/07/2020 |
Last Update Date | 10/12/2020 |
Medicare PECOS PAC ID | 5597175950 |
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Medicare Enrollment ID | O20201113001512 |
Identifier | Type | State | Issuer |
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1578181491 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
Provider Name | Michael R Kostura |
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Provider Type | Practitioner - Optometry |
Provider Identifiers | NPI Number: 1700913829 PECOS PAC ID: 4688660350 Enrollment ID: I20040427000678 |
Provider Name | Joanna Kao Hsia |
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Provider Type | Practitioner - Optometry |
Provider Identifiers | NPI Number: 1255631578 PECOS PAC ID: 9638336936 Enrollment ID: I20120127000716 |