Provider Demographics
NPI:1487228516
Name:CASTRO, MEGGIE (OD)
Entity type:Individual
Prefix:
First Name:MEGGIE
Middle Name:
Last Name:CASTRO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 MALAGA
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-5957
Mailing Address - Country:US
Mailing Address - Phone:714-943-3984
Mailing Address - Fax:
Practice Address - Street 1:25260 LA PAZ RD STE G
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-5132
Practice Address - Country:US
Practice Address - Phone:949-586-8200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-13
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35634152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist