MEDICARE: MR. ADRIAN CASTANEDA ABOC

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	156FX1800X	Optician	DR4082	TX

General Provider Information

NPI Number	:	1124340740
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ADRIAN CASTANEDA ABOC

Provider Business Mailing Address
First Line	:	4042 MIHO
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78223-3822
Country	:	US
Telephone Number	:	210-337-5243
Fax Number	:

Provider Business Practice Location Address
First Line	:	4042 MIHO
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78223-3822
Country	:	US
Telephone Number	:	210-337-5243
Fax Number	:

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

Provider Enumeration Date	:	02/23/2010
Last Update Date	:	02/23/2010

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