Willie B Castleberry III, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

5767TG Issued in TX

Practice address

3111 Midwestern Pkwy
Ste 256a
Wichita Falls, TX 76308-2823

Phone

(940) 691-0224

Fax

(940) 691-0225

NPI assigned

Aug 9, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Colin Castleberry Professional name

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Ja McCall Clinic LLC

  • Optometrist
  • Crockett, TX
  • NPI 1063983039
  Medicare reassignment NPD
• Colin Castleberry PC

  • Optometrist
  • Wichita Falls, TX
  • NPI 1447433438
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155081600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1485993600000",
    "number": "1871503128",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "711 E GOLIAD AVE",
            "address_2": "STE 256A",
            "city": "CROCKETT",
            "state": "TX",
            "postal_code": "758352140",
            "telephone_number": "936-544-3763",
            "fax_number": "936-544-7894"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3111 MIDWESTERN PKWY",
            "address_2": "STE 256A",
            "city": "WICHITA FALLS",
            "state": "TX",
            "postal_code": "763082823",
            "telephone_number": "940-691-0224",
            "fax_number": "940-691-0225"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CASTLEBERRY",
        "first_name": "WILLIE",
        "middle_name": "B",
        "name_suffix": "III",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-09",
        "last_updated": "2017-02-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "TX",
            "license": "5767TG",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "80322Q",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "COLIN",
            "last_name": "CASTLEBERRY",
            "credential": "O.D.",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Ty Casados
• Katherine Elaine Case, FNP-C
• Cassandra Rae Caskey, LVN
• Kevin Castillo, RN
• Jean M Castle, LPC
• Damarcus Causey, DMD
• Julie Cavazos, SLP
• Glenn Lee Cavett, D.C.
• Cedar Crest Clinic
• Ayres R Cermin

• Optometrist in Wichita Falls, TX
• Providers in Wichita Falls, TX by specialty
• Optometrist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.