Healthcare Provider Details

I. General information

NPI: 1073601514
Provider Name (Legal Business Name): KAREN Y CASTLEBERRY O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 01/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 ATLANTA HWY #141
ATHENS GA
30606-7201
US

IV. Provider business mailing address

3700 ATLANTA HWY SUITE 141
ATHENS GA
30606-7201
US

V. Phone/Fax

Practice location:
  • Phone: 706-613-6409
  • Fax: 706-613-5514
Mailing address:
  • Phone: 706-613-6409
  • Fax: 706-613-5514

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number1324
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number3628
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: