Provider Demographics
NPI:1659472587
Name:CASTRO, MAX ANTHONY (OPTICIAN)
Entity type:Individual
Prefix:MR
First Name:MAX
Middle Name:ANTHONY
Last Name:CASTRO
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4602 N ARMENIA A-1
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33603-2625
Mailing Address - Country:US
Mailing Address - Phone:813-875-5480
Mailing Address - Fax:813-875-5480
Practice Address - Street 1:4602 N ARMENIA
Practice Address - Street 2:SUITE A-1
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33603-2625
Practice Address - Country:US
Practice Address - Phone:813-875-5480
Practice Address - Fax:813-875-5480
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL891156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL086031000Medicaid
FL084857001Medicare ID - Type Unspecified