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NPI Code Detail

MEDICARE: KIM A CASTLEBERRY O.D.

MEDICARE: KIM A 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
1152W00000XOptometrist3161TGTX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1841213576
Entity Type Code : Individual
Provider Name (Legal Business Name) : KIM A CASTLEBERRY O.D.
Provider Business Mailing Address
First Line : 5900 COIT RD
Second Line :
City : PLANO
State : TX
Zip : 75023-5959
Country : US
Telephone Number : 972-985-1412
Fax Number : 972-964-5758
Provider Business Practice Location Address
First Line : 5900 COIT RD
Second Line :
City : PLANO
State : TX
Zip : 75023-5959
Country : US
Telephone Number : 972-985-1412
Fax Number : 972-964-5758
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/25/2006
Last Update Date : 02/18/2013

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