Provider Demographics
NPI:1417841040
Name:CASTELLANOS, KIMBERLY (OD)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:CASTELLANOS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5542 W SACRAMENTO CT
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32821-7938
Mailing Address - Country:US
Mailing Address - Phone:321-276-6610
Mailing Address - Fax:
Practice Address - Street 1:3640 MAIN ST STE 205
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01107-1139
Practice Address - Country:US
Practice Address - Phone:413-739-7367
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-06
Last Update Date:2025-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1202XEye and Vision Services ProvidersTechnician/TechnologistOptometric Technician