Provider Demographics
NPI:1396983722
Name:OCULOFACIAL PLASTIC SURGERY, PLLC
Entity type:Organization
Organization Name:OCULOFACIAL PLASTIC SURGERY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MD
Authorized Official - Prefix:DR
Authorized Official - First Name:JON
Authorized Official - Middle Name:CURTIS
Authorized Official - Last Name:CASTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:936-560-5437
Mailing Address - Street 1:PO BOX 631624
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75963-1624
Mailing Address - Country:US
Mailing Address - Phone:936-560-5437
Mailing Address - Fax:
Practice Address - Street 1:1105 N UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75961-4211
Practice Address - Country:US
Practice Address - Phone:936-560-5437
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-22
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ25262082S0099X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No2082S0099XAllopathic & Osteopathic PhysiciansPlastic SurgeryPlastic Surgery Within the Head and NeckGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG03682Medicare UPIN