Basic Information
Provider Information
NPI: 1760840680
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CASTREJON
FirstName: FRANCO
MiddleName: JASON
NamePrefix: DR.
NameSuffix:  
Credential: OPTOMETRIST
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2050 S BLOSSER RD
Address2:  
City: SANTA MARIA
State: CA
PostalCode: 934587310
CountryCode: US
TelephoneNumber: 8053618023
FaxNumber: 8053618097
Practice Location
Address1: 150 TEJAS PL
Address2:  
City: NIPOMO
State: CA
PostalCode: 934449123
CountryCode: US
TelephoneNumber: 8059293211
FaxNumber: 8059296359
Other Information
ProviderEnumerationDate: 02/05/2016
LastUpdateDate: 03/06/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
152W00000XOPT:33343TLGCAY Eye and Vision Services ProvidersOptometrist 

No ID Information.


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