MEDICARE: DR. KAREN Y CASTLEBERRY O.D.

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	152WC0802X	Corneal and Contact Management Optometrist	1324	GA
2	152WC0802X	Corneal and Contact Management Optometrist	3628	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	10633	OTHER	GA	COLE LOCATION #102007
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	41ZCFDD	OTHER	GA	CARRIER PROVIDER #

General Provider Information

NPI Number	:	1073601514
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KAREN Y CASTLEBERRY O.D.

Provider Business Mailing Address
First Line	:	3700 ATLANTA HWY
Second Line	:	SUITE 141
City	:	ATHENS
State	:	GA
Zip	:	30606-7201
Country	:	US
Telephone Number	:	706-613-6409
Fax Number	:	706-613-5514

Provider Business Practice Location Address
First Line	:	3700 ATLANTA HWY
Second Line	:	#141
City	:	ATHENS
State	:	GA
Zip	:	30606-7201
Country	:	US
Telephone Number	:	706-613-6409
Fax Number	:	706-613-5514

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

Provider Enumeration Date	:	10/10/2006
Last Update Date	:	01/26/2010

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