MEDICARE: DR. CLORIS CASTRO 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	OPT35052TLG	CA

General Provider Information

NPI Number	:	1912662511
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CLORIS CASTRO OD

Provider Business Mailing Address
First Line	:	940 N FAIRFAX AVE
Second Line	:
City	:	WEST HOLLYWOOD
State	:	CA
Zip	:	90046
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	940 N FAIRFAX AVE
Second Line	:
City	:	WEST HOLLYWOOD
State	:	CA
Zip	:	90046
Country	:	US
Telephone Number	:	323-651-5646
Fax Number	:

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

Provider Enumeration Date	:	11/08/2021
Last Update Date	:	12/01/2025

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