MEDICARE: DR. STEPHANIE CASTLE 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	79601449934	UT

General Provider Information

NPI Number	:	1679887962
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHANIE CASTLE OD

Provider Business Mailing Address
First Line	:	6584 CREEKSIDE DR
Second Line	:
City	:	PARK CITY
State	:	UT
Zip	:	84098-5532
Country	:	US
Telephone Number	:	435-649-5200
Fax Number	:

Provider Business Practice Location Address
First Line	:	6584 CREEKSIDE DR
Second Line	:
City	:	PARK CITY
State	:	UT
Zip	:	84098-5532
Country	:	US
Telephone Number	:	435-649-5200
Fax Number	:

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

Provider Enumeration Date	:	07/29/2010
Last Update Date	:	07/12/2012

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