Provider Demographics
NPI:1326718347
Name:GIANNIE CASTELLANOS OD PA
Entity Type:Organization
Organization Name:GIANNIE CASTELLANOS OD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GIANNIE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:CASTELLANOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-251-5834
Mailing Address - Street 1:6807 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-2047
Mailing Address - Country:US
Mailing Address - Phone:786-251-5834
Mailing Address - Fax:
Practice Address - Street 1:6807 MAIN ST
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-2047
Practice Address - Country:US
Practice Address - Phone:786-717-7775
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-20
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001425700Medicaid