Provider Demographics
NPI:1568482628
Name:CASTILLO, JOSE A (OD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:A
Last Name:CASTILLO
Suffix:
Gender:M
Credentials:OD
Other - Prefix:DR
Other - First Name:JOSE
Other - Middle Name:A
Other - Last Name:CASTILLO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:12163 GRAND PINE DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224-4435
Mailing Address - Country:US
Mailing Address - Phone:305-205-5955
Mailing Address - Fax:
Practice Address - Street 1:4250 PHILIPS HWY
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-6730
Practice Address - Country:US
Practice Address - Phone:786-478-3554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC2849152WP0200X, 152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL620096600Medicaid
FL20589Medicare PIN
FLU57674Medicare UPIN