Healthcare Provider Details

I. General information

NPI: 1356327407
Provider Name (Legal Business Name): WAYNE M CASTAGNA O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2005
Last Update Date: 01/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23C FIELDSTONE CMNS GROVE HILL MEDICAL CENTER
TOLLAND CT
06084-3422
US

IV. Provider business mailing address

23C FIELDSTONE CMNS GROVE HILL MEDICAL CENTER
TOLLAND CT
06084-3422
US

V. Phone/Fax

Practice location:
  • Phone: 860-826-4460
  • Fax: 860-826-4436
Mailing address:
  • Phone: 860-826-4460
  • Fax: 860-826-4436

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number002472
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: