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General NPI Number Information
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NPI Number | 1821135526
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Entity Type | Individual
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Provider Name | CHRISTOPHER ROBERT DECASTECKER O.D.
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Gender | Male
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Dates
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Enumeration Date | 01/31/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 34690 VINE ST
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City | WILLOWICK
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State | OH
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Zip | 44095-5118
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Country | US
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Telephone | 440-946-6662
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Fax | 440-946-6981
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Provider Business Mailing Address
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Address Line | 32560 SENECA DR
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City | SOLON
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State | OH
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Zip | 44139-6302
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Country | US
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Telephone | 440-542-0137
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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 | 4512
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License Number State | OH
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