Provider Demographics
NPI:1063911576
Name:CASTILLO, KIMBERLY (OD)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:CASTILLO
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 1:465 W CHANNEL ISLANDS BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT HUENEME
Mailing Address - State:CA
Mailing Address - Zip Code:93041-2102
Mailing Address - Country:US
Mailing Address - Phone:805-486-3585
Mailing Address - Fax:805-486-3586
Practice Address - Street 1:465 W CHANNEL ISLANDS BLVD
Practice Address - Street 2:
Practice Address - City:PORT HUENEME
Practice Address - State:CA
Practice Address - Zip Code:93041-2102
Practice Address - Country:US
Practice Address - Phone:805-486-3585
Practice Address - Fax:805-485-4400
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-09
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33881TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist