1770777914 NPI number — DR. ROBERT BASTAICH & ASSOC.

Table of content: (NPI 1770777914)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770777914 NPI number — DR. ROBERT BASTAICH & ASSOC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR. ROBERT BASTAICH & ASSOC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1770777914
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/30/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2501 SHEILA LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RICHMOND
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23225-2041
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
804-320-9457
Provider Business Mailing Address Fax Number:
804-320-9458

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2501 SHEILA LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RICHMOND
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23225-2041
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-320-9457
Provider Business Practice Location Address Fax Number:
804-320-9458
Provider Enumeration Date:
08/30/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BASTAICH
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
Authorized Official Title or Position:
OPTOMETRIST
Authorized Official Telephone Number:
804-320-9457

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  0618001635 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1609808880 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com