MEDICARE: DR. JOSE A. CASTILLO O.D.

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	152WP0200X	Pediatric Optometrist	OPC2849	FL
2	152W00000X	Optometrist	OPC2849	FL
3	152WC0802X	Corneal and Contact Management Optometrist	OPC2849	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568482628
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSE A. CASTILLO O.D.

Provider Business Mailing Address
First Line	:	12163 GRAND PINE DR
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32224-4435
Country	:	US
Telephone Number	:	305-205-5955
Fax Number	:

Provider Business Practice Location Address
First Line	:	4250 PHILIPS HWY
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32207-6730
Country	:	US
Telephone Number	:	786-478-3554
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/20/2006
Last Update Date	:	01/22/2025

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