Provider Demographics
NPI:1265428841
Name:CASTROVINCI, ROBERT VINCENT (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:VINCENT
Last Name:CASTROVINCI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2817 NEW PINERY ROAD
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:WI
Mailing Address - Zip Code:53901-0387
Mailing Address - Country:US
Mailing Address - Phone:608-745-5600
Mailing Address - Fax:608-745-5098
Practice Address - Street 1:2817 NEW PINERY ROAD
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:WI
Practice Address - Zip Code:53901-0387
Practice Address - Country:US
Practice Address - Phone:608-745-5600
Practice Address - Fax:608-745-5098
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2017-03-08
Deactivation Date:2006-03-24
Deactivation Code:
Reactivation Date:2006-04-03
Provider Licenses
StateLicense IDTaxonomies
WI18851-020207W00000X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI2025707OtherPHYSICIANS PLUS
WI34890400Medicaid
WI2025707OtherPHYSICIANS PLUS
WIP00331192Medicare PIN
WI001047810Medicare PIN
WI001947805Medicare PIN
WI001047810Medicare PIN