Provider Demographics
NPI:1427344423
Name:CASTELLANO, JOSEPH CARMEN (OD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:CARMEN
Last Name:CASTELLANO
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2511 S BRENTWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63144-2308
Mailing Address - Country:US
Mailing Address - Phone:314-863-0000
Mailing Address - Fax:314-961-1041
Practice Address - Street 1:2511 S BRENTWOOD BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63144-2308
Practice Address - Country:US
Practice Address - Phone:314-863-0000
Practice Address - Fax:314-961-1041
Is Sole Proprietor?:No
Enumeration Date:2011-06-28
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO201101721152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO149900001Medicare PIN