Active NPI
Sandy L Costello, O.D.
- Optometrist
- Lantana, FL
National Provider Identifier
1639129869
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 1024
- Practice address
- 1280 W Lantana Rd
Suite 1
Lantana, FL 33462-1543 - Phone
- (561) 582-3383
- Fax
- (561) 582-8821
- NPI assigned
- May 10, 2006
- Last updated
- Sep 15, 2010
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 1024 | FL | Primary |
Addresses
Primary practice location
1280 W Lantana Rd
Suite 1
Lantana, FL 33462-1543
Mailing address
1280 W Lantana Rd
Suite 1
Lantana, FL 33462-1543
Phone (561) 582-3383
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 078710800 | Medicaid | FL | |
| 410010723 | Other | FL | RAILROAD MEDICARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1024 | FL | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147219200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1284508800000",
"number": "1639129869",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1280 W LANTANA RD",
"address_2": "SUITE 1",
"city": "LANTANA",
"state": "FL",
"postal_code": "334621543",
"telephone_number": "561-582-3383",
"fax_number": "561-582-8821"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1280 W LANTANA RD",
"address_2": "SUITE 1",
"city": "LANTANA",
"state": "FL",
"postal_code": "334621543",
"telephone_number": "561-582-3383",
"fax_number": "561-582-8821"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COSTELLO",
"first_name": "SANDY",
"middle_name": "L",
"credential": "O.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-10",
"last_updated": "2010-09-15",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "FL",
"license": "1024",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "078710800",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "410010723",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lantana, FL
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- Costco Wholesale Corporation
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- Courtney S, Scott, MD, a Professional Association
- Brit Courtney, CNM, ARNP
- Covenant Care Treatment Services
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- Sandra Elaine Dacosta, ARNP
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.