MEDICARE: DR. WAYNE M CASTAGNA 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	152W00000X	Optometrist	002472	CT

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

General Provider Information

NPI Number	:	1356327407
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WAYNE M CASTAGNA O.D.

Provider Business Mailing Address
First Line	:	23C FIELDSTONE CMNS
Second Line	:	GROVE HILL MEDICAL CENTER
City	:	TOLLAND
State	:	CT
Zip	:	06084-3422
Country	:	US
Telephone Number	:	860-826-4460
Fax Number	:	860-826-4436

Provider Business Practice Location Address
First Line	:	23C FIELDSTONE CMNS
Second Line	:	GROVE HILL MEDICAL CENTER
City	:	TOLLAND
State	:	CT
Zip	:	06084-3422
Country	:	US
Telephone Number	:	860-826-4460
Fax Number	:	860-826-4436

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

Provider Enumeration Date	:	12/21/2005
Last Update Date	:	01/08/2016

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