Provider Demographics
NPI:1154493039
Name:CASTRO, VALERIA (OD)
Entity Type:Individual
Prefix:
First Name:VALERIA
Middle Name:
Last Name:CASTRO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:VALERIA
Other - Middle Name:
Other - Last Name:CASAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:7153 CERMAK RD
Mailing Address - Street 2:
Mailing Address - City:BERWYN
Mailing Address - State:IL
Mailing Address - Zip Code:60402-2103
Mailing Address - Country:US
Mailing Address - Phone:708-795-8585
Mailing Address - Fax:708-795-8648
Practice Address - Street 1:7153 CERMAK RD
Practice Address - Street 2:
Practice Address - City:BERWYN
Practice Address - State:IL
Practice Address - Zip Code:60402-2103
Practice Address - Country:US
Practice Address - Phone:708-795-8585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILL92880Medicare UPIN
ILK12196Medicare ID - Type Unspecified