Provider Demographics
NPI:1023754546
Name:KASHAT, AUSTIN AYAD (OD)
Entity type:Individual
Prefix:
First Name:AUSTIN
Middle Name:AYAD
Last Name:KASHAT
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47300 W 10 MILE RD
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48374-2917
Mailing Address - Country:US
Mailing Address - Phone:248-782-2777
Mailing Address - Fax:248-782-2999
Practice Address - Street 1:47300 W 10 MILE RD
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48374
Practice Address - Country:US
Practice Address - Phone:248-782-2777
Practice Address - Fax:248-782-2999
Is Sole Proprietor?:No
Enumeration Date:2022-05-08
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901005618APP22152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist