Individual
DR. ANTHONY KOSTALLAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
6325 PACIFIC BLVD, STE. 104, HUNTINGTON PARK, CA 90255-4100
(323) 581-4466
(323) 587-8650
Mailing address
6325 PACIFIC BLVD, STE. 104, HUNTINGTON PARK, CA 90255-4100
(323) 581-4466
(323) 587-8650
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
6482T
CA
152WC0802X
Corneal and Contact Management Optometrist
6482T
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
SD0064820
—
CA
Enumeration date
12/28/2005
Last updated
09/11/2025
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