Provider Demographics
NPI:1689893208
Name:CASTRO SOLIS, INC.
Entity Type:Organization
Organization Name:CASTRO SOLIS, INC.
Other - Org Name:OPTICA CENTRO YABUCOA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:IDA
Authorized Official - Middle Name:R
Authorized Official - Last Name:CASTRO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:787-638-4165
Mailing Address - Street 1:11 CALLE SANTIAGO VIDARTE
Mailing Address - Street 2:
Mailing Address - City:YABUCOA
Mailing Address - State:PR
Mailing Address - Zip Code:00767-3303
Mailing Address - Country:US
Mailing Address - Phone:787-638-4165
Mailing Address - Fax:787-893-0643
Practice Address - Street 1:14 CRISTOBAL COLON
Practice Address - Street 2:
Practice Address - City:YABUCOA
Practice Address - State:PR
Practice Address - Zip Code:00767
Practice Address - Country:US
Practice Address - Phone:787-893-0643
Practice Address - Fax:787-893-0643
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR575152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR57970Medicare ID - Type Unspecified