Healthcare Provider Details

I. General information

NPI: 1396983722
Provider Name (Legal Business Name): OCULOFACIAL PLASTIC SURGERY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2009
Last Update Date: 12/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1105 N UNIVERSITY DR
NACOGDOCHES TX
75961-4211
US

IV. Provider business mailing address

PO BOX 631624
NACOGDOCHES TX
75963-1624
US

V. Phone/Fax

Practice location:
  • Phone: 936-560-5437
  • Fax:
Mailing address:
  • Phone: 936-560-5437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2082S0099X
TaxonomyPlastic Surgery Within the Head and Neck (Plastic Surgery) Physician
License NumberJ2526
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberJ2526
License Number StateTX

VIII. Authorized Official

Name: DR. JON CURTIS CASTER
Title or Position: OWNER/MD
Credential: M.D.
Phone: 936-560-5437