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General NPI Number Information
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NPI Number | 1295359230
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Entity Type | Individual
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Provider Name | HAILEY ALYSSA CASTRO
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Gender | Female
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Dates
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Enumeration Date | 06/05/2020
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Last Update Date | 06/05/2020
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Provider Practice Location Address
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Address Line | 2150 NORTHWOODS BLVD UNIT E2
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City | NORTH CHARLESTON
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State | SC
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Zip | 29406-4043
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Country | US
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Telephone | 843-569-3937
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Fax |
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Provider Business Mailing Address
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Address Line | 1428 WATER OAK CUT
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City | MOUNT PLEASANT
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State | SC
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Zip | 29466-8080
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Country | US
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Telephone | 505-506-4764
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPT.2186
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License Number State | SC
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