Provider Demographics
NPI:1518720382
Name:KIMBERLY S CASTELLUCCI OD PLLC
Entity Type:Organization
Organization Name:KIMBERLY S CASTELLUCCI OD PLLC
Other - Org Name:WELLSBURG VISION CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:S
Authorized Official - Last Name:CASTELLUCCI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:757-403-2405
Mailing Address - Street 1:9 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-5732
Mailing Address - Country:US
Mailing Address - Phone:757-403-2405
Mailing Address - Fax:
Practice Address - Street 1:99 7TH ST
Practice Address - Street 2:
Practice Address - City:WELLSBURG
Practice Address - State:WV
Practice Address - Zip Code:26070-1656
Practice Address - Country:US
Practice Address - Phone:304-737-3440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-05
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty