Provider Demographics
NPI:1508815275
Name:CASTRO, JOHN EDWIN (OD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:EDWIN
Last Name:CASTRO
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 1:3303 S LINDSAY RD
Mailing Address - Street 2:STE 101
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-6503
Mailing Address - Country:US
Mailing Address - Phone:480-292-9835
Mailing Address - Fax:480-292-9836
Practice Address - Street 1:3303 S LINDSAY RD
Practice Address - Street 2:STE 101
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-6503
Practice Address - Country:US
Practice Address - Phone:480-292-9835
Practice Address - Fax:480-292-9836
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1014152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist