Provider Demographics
NPI:1285842740
Name:CASTILLO, GUSTAVO A (OD)
Entity Type:Individual
Prefix:DR
First Name:GUSTAVO
Middle Name:A
Last Name:CASTILLO
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:570 HATFIELD DR
Mailing Address - Street 2:
Mailing Address - City:UMATILLA
Mailing Address - State:FL
Mailing Address - Zip Code:32784-8986
Mailing Address - Country:US
Mailing Address - Phone:352-729-9037
Mailing Address - Fax:352-669-1015
Practice Address - Street 1:570 HATFIELD DR
Practice Address - Street 2:
Practice Address - City:UMATILLA
Practice Address - State:FL
Practice Address - Zip Code:32784-8986
Practice Address - Country:US
Practice Address - Phone:352-243-2724
Practice Address - Fax:863-353-6842
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2017-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL004008152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1245561893OtherGROUP NPI