Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician |
NPI | 1013019603 |
---|---|
Provider Name | Kathleen Bastone |
First Address | Umatilla, FL 32784-9359 |
Second Address | Umatilla, FL 32784-8986 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/09/2006 |
Last Update Date | 05/03/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
086623700 | (05) | FL |
086623701 | (05) | FL |
2100002 | UNITED HEALTHCARE (01) | FL |
593024353 | I.D. NUMBER (01) | FL |
610136400 | (05) | FL |
FL3146 | EYE MED (01) | FL |