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Organization
VITA PARK EYE ASSOCIATES, SC
Active
Organization
VITA PARK EYE ASSOCIATES, SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS A CASTILLO DO (CORPORATE OFFICER)
(920) 887-1151
Entity
Organization
Contact information
Practice address
240 CORPORATE DRIVE, BEAVER DAM, WI 53916
(920) 887-1151
(920) 887-3353
Mailing address
240 CORPORATE DRIVE, BEAVER DAM, WI 53916
(920) 887-1151
(920) 887-3353
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
—
NULL
152W00000X
Optometrist
—
—
207W00000X
Ophthalmology Physician
Primary
—
NULL
207W00000X
Ophthalmology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
21310700
—
WI
01
—
CP765
RAIL ROAD MEDICARE
WI
Enumeration date
10/10/2006
Last updated
04/21/2021
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