MEDICARE: DR. CHRISTINE 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	152W00000X	Optometrist	6433TG	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	221639	OTHER	TX	EYEMED &AETNA PROVIDER ID

General Provider Information

NPI Number	:	1780747279
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTINE CASTILLO O.D.

Provider Business Mailing Address
First Line	:	7487 BROMPTON ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77025-2265
Country	:	US
Telephone Number	:	832-606-3464
Fax Number	:

Provider Business Practice Location Address
First Line	:	6737 STELLA LINK RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77005-4342
Country	:	US
Telephone Number	:	713-432-1137
Fax Number	:	713-660-9909

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

Provider Enumeration Date	:	12/18/2006
Last Update Date	:	07/08/2007

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