Provider Demographics
NPI:1275556094
Name:CASTELLANO, PERRY J (OD)
Entity Type:Individual
Prefix:DR
First Name:PERRY
Middle Name:J
Last Name:CASTELLANO
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7402 ALESTONE DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28411-9679
Mailing Address - Country:US
Mailing Address - Phone:910-681-0958
Mailing Address - Fax:
Practice Address - Street 1:5351 GINGERWOOD DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28405
Practice Address - Country:US
Practice Address - Phone:910-392-5707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1898152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1898OtherOPTOMETRIC LICENSE - NC
NC1898OtherOPTOMETRIC LICENSE - NC
NC2458106Medicare ID - Type Unspecified