| 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 |
|---|---|
| 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 |
|---|---|
| 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 |
|---|---|
| Provider Enumeration Date | 07/07/2020 |
| Last Update Date | 10/12/2020 |
| Medicare PECOS PAC ID | 5597175950 |
|---|---|
| Medicare Enrollment ID | O20201113001512 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578181491 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Michael R Kostura |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1700913829 PECOS PAC ID: 4688660350 Enrollment ID: I20040427000678 |
| Provider Name | Joanna Kao Hsia |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1255631578 PECOS PAC ID: 9638336936 Enrollment ID: I20120127000716 |