Provider Demographics
NPI:1205014974
Name:CATHERINE SPOO CASTLEBERRY O.D., P.A.
Entity Type:Organization
Organization Name:CATHERINE SPOO CASTLEBERRY O.D., P.A.
Other - Org Name:CATHERINE SPOO CASTLEBERRY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:SPOO
Authorized Official - Last Name:CASTLEBERRY
Authorized Official - Suffix:
Authorized Official - Credentials:OD, PA
Authorized Official - Phone:940-891-0484
Mailing Address - Street 1:2524 LILLIAN MILLER PARKWAY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76210
Mailing Address - Country:US
Mailing Address - Phone:940-891-0484
Mailing Address - Fax:940-383-4700
Practice Address - Street 1:2524 LILLIAN MILLER PARKWAY
Practice Address - Street 2:SUITE 100
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76210
Practice Address - Country:US
Practice Address - Phone:940-891-0484
Practice Address - Fax:940-383-4700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-05
Last Update Date:2013-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3870TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
00962YMedicare PIN
TXT86247Medicare UPIN
6709570001Medicare NSC
TX00962YMedicare PIN