Provider Demographics
NPI:1265165369
Name:GIANNIE CASTELLANOS OD PA
Entity type:Organization
Organization Name:GIANNIE CASTELLANOS OD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:GIANNIE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:CASTELLANOS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:786-251-5834
Mailing Address - Street 1:8060 NW 155TH ST STE 201
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33016-5883
Mailing Address - Country:US
Mailing Address - Phone:305-364-3737
Mailing Address - Fax:
Practice Address - Street 1:11099 SW 10TH ST PG 6 #160
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33199-2516
Practice Address - Country:US
Practice Address - Phone:305-364-3737
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GIANNIE CASTELLANOS OD PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-07-06
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty