Provider Demographics
NPI:1730168071
Name:CASTLETON, KEITH J (OD)
Entity type:Individual
Prefix:DR
First Name:KEITH
Middle Name:J
Last Name:CASTLETON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5961 S LOS ALTOS PKWY STE 101
Mailing Address - Street 2:STE 101
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89436-2501
Mailing Address - Country:US
Mailing Address - Phone:775-359-2020
Mailing Address - Fax:775-359-2676
Practice Address - Street 1:660 S 200 E STE 250
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84111-3846
Practice Address - Country:US
Practice Address - Phone:801-359-2256
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5350538-9934152W00000X
AZ1475152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV37415Medicare UPIN
U000074711Medicare UPIN