Provider Demographics
NPI:1619110087
Name:CASTLETON EYECARE INC
Entity Type:Organization
Organization Name:CASTLETON EYECARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CODER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SYLVIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-849-9921
Mailing Address - Street 1:8137 CASTLETON RD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2035
Mailing Address - Country:US
Mailing Address - Phone:317-849-9921
Mailing Address - Fax:317-913-1404
Practice Address - Street 1:8137 CASTLETON RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250-2035
Practice Address - Country:US
Practice Address - Phone:317-849-9921
Practice Address - Fax:317-913-1404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-14
Last Update Date:2009-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18001512A332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN426300Medicare PIN