Provider Demographics
NPI:1821135526
Name:DECASTECKER, CHRISTOPHER ROBERT (OD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:ROBERT
Last Name:DECASTECKER
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 1:32560 SENECA DR
Mailing Address - Street 2:
Mailing Address - City:SOLON
Mailing Address - State:OH
Mailing Address - Zip Code:44139-6302
Mailing Address - Country:US
Mailing Address - Phone:440-542-0137
Mailing Address - Fax:
Practice Address - Street 1:34690 VINE ST
Practice Address - Street 2:
Practice Address - City:WILLOWICK
Practice Address - State:OH
Practice Address - Zip Code:44095-5118
Practice Address - Country:US
Practice Address - Phone:440-946-6662
Practice Address - Fax:440-946-6981
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4512152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2197046Medicaid
OHU49047Medicare UPIN
OHCR0848981Medicare ID - Type Unspecified