Provider Demographics
NPI:1356327407
Name:CASTAGNA, WAYNE M (OD)
Entity Type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:M
Last Name:CASTAGNA
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 1:23C FIELDSTONE CMNS
Mailing Address - Street 2:GROVE HILL MEDICAL CENTER
Mailing Address - City:TOLLAND
Mailing Address - State:CT
Mailing Address - Zip Code:06084-3422
Mailing Address - Country:US
Mailing Address - Phone:860-826-4460
Mailing Address - Fax:860-826-4436
Practice Address - Street 1:23C FIELDSTONE CMNS
Practice Address - Street 2:GROVE HILL MEDICAL CENTER
Practice Address - City:TOLLAND
Practice Address - State:CT
Practice Address - Zip Code:06084-3422
Practice Address - Country:US
Practice Address - Phone:860-826-4460
Practice Address - Fax:860-826-4436
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2016-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002472152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004239663Medicaid
CT004239663Medicaid
CT410001106Medicare ID - Type Unspecified