Provider Demographics
NPI:1538253489
Name:CASTLEBERRY, CATHERINE S (OD)
Entity type:Individual
Prefix:DR
First Name:CATHERINE
Middle Name:S
Last Name:CASTLEBERRY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:KATIE
Other - Middle Name:S
Other - Last Name:RIPPLEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:2524 LILLIAN MILLER PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76210-7206
Mailing Address - Country:US
Mailing Address - Phone:940-891-0484
Mailing Address - Fax:940-383-4700
Practice Address - Street 1:2524 LILLIAN MILLER PARKWAY
Practice Address - Street 2:SUITE 100
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76210
Practice Address - Country:US
Practice Address - Phone:940-891-0484
Practice Address - Fax:940-383-4700
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2013-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3870TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXT86247Medicare UPIN
TX8F0306Medicare ID - Type Unspecified
TX6709570001Medicare NSC