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General NPI Number Information
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NPI Number | 1396983722
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Entity Type | Organization
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Legal Business Name | OCULOFACIAL PLASTIC SURGERY, PLLC
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Dates
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Enumeration Date | 01/22/2009
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Last Update Date | 12/01/2011
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Provider Practice Location Address
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Address Line | 1105 N UNIVERSITY DR
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City | NACOGDOCHES
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State | TX
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Zip | 75961-4211
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Country | US
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Telephone | 936-560-5437
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 631624
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City | NACOGDOCHES
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State | TX
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Zip | 75963-1624
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Country | US
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Telephone | 936-560-5437
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Fax |
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Authorized Official
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Title or Position | OWNER/MD
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Name | DR. JON CURTIS CASTER
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Credential | M.D.
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Telephone | 936-560-5437
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2082S0099X
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Taxonomy Name | Plastic Surgery Within the Head and Neck (Plastic Surgery) Physician
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License Number | J2526
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | J2526
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License Number State | TX
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