Healthcare Provider Details

I. General information

NPI: 1811818651
Provider Name (Legal Business Name): JOHN VINCENT CASTILLO OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2026
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2150 NORTHWOODS BLVD UNIT E2
NORTH CHARLESTON SC
29406-4043
US

IV. Provider business mailing address

470 TOWN CENTER PL STE 5
COLUMBIA SC
29229-7957
US

V. Phone/Fax

Practice location:
  • Phone: 843-829-2020
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2618
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: