MEDICARE: KIMBERLY S CASTELLUCCI OD PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist

General Provider Information

NPI Number	:	1518720382
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KIMBERLY S CASTELLUCCI OD PLLC

Provider Business Mailing Address
First Line	:	9 MAPLE AVE
Second Line	:
City	:	WHEELING
State	:	WV
Zip	:	26003-5732
Country	:	US
Telephone Number	:	757-403-2405
Fax Number	:

Provider Business Practice Location Address
First Line	:	99 7TH ST
Second Line	:
City	:	WELLSBURG
State	:	WV
Zip	:	26070-1656
Country	:	US
Telephone Number	:	304-737-3440
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. KIMBERLY S CASTELLUCCI
Credential	:	OD
Telephone Number	:	757-403-2405

Provider Enumeration Date	:	02/05/2024
Last Update Date	:	03/04/2024

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