Provider Demographics
NPI:1396544953
Name:CASTILLO, ISAI (OPT)
Entity type:Individual
Prefix:
First Name:ISAI
Middle Name:
Last Name:CASTILLO
Suffix:
Gender:M
Credentials:OPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14045 FM 2100 RD STE 180
Mailing Address - Street 2:
Mailing Address - City:CROSBY
Mailing Address - State:TX
Mailing Address - Zip Code:77532-6595
Mailing Address - Country:US
Mailing Address - Phone:281-462-4279
Mailing Address - Fax:
Practice Address - Street 1:14045 FM 2100 RD STE 180
Practice Address - Street 2:
Practice Address - City:CROSBY
Practice Address - State:TX
Practice Address - Zip Code:77532-6595
Practice Address - Country:US
Practice Address - Phone:281-462-4279
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-07
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier