MEDICARE: KIMBERLY CASTILLO OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	33881TLG	CA

General Provider Information

NPI Number	:	1063911576
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY CASTILLO OD

Provider Business Mailing Address
First Line	:	465 W CHANNEL ISLANDS BLVD
Second Line	:
City	:	PORT HUENEME
State	:	CA
Zip	:	93041-2102
Country	:	US
Telephone Number	:	805-486-3585
Fax Number	:	805-486-3586

Provider Business Practice Location Address
First Line	:	465 W CHANNEL ISLANDS BLVD
Second Line	:
City	:	PORT HUENEME
State	:	CA
Zip	:	93041-2102
Country	:	US
Telephone Number	:	805-486-3585
Fax Number	:	805-485-4400

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/09/2018
Last Update Date	:	02/25/2022

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Directions to “ KIMBERLY CASTILLO OD” Practice Location

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