Provider Demographics
NPI:1770190779
Name:CASTILLO, NATE RICHARD (OD)
Entity Type:Individual
Prefix:DR
First Name:NATE
Middle Name:RICHARD
Last Name:CASTILLO
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 1:2625 CAMBRIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:TAHLEQUAH
Mailing Address - State:OK
Mailing Address - Zip Code:74464-4690
Mailing Address - Country:US
Mailing Address - Phone:918-704-6245
Mailing Address - Fax:
Practice Address - Street 1:2625 CAMBRIDGE CIR
Practice Address - Street 2:
Practice Address - City:TAHLEQUAH
Practice Address - State:OK
Practice Address - Zip Code:74464-4690
Practice Address - Country:US
Practice Address - Phone:918-704-6245
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-24
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3059152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist