1861710410 NPI number — YOLANDA BASTAICH O.D.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861710410 NPI number — YOLANDA BASTAICH O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
YOLANDA BASTAICH O.D.
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:
1861710410
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/06/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
104 LINCOLN AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLEROI
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15022-1432
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-518-6263
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2100 SUMMIT RIDGE PLZ
Provider Second Line Business Practice Location Address:
WALMART VISION CENTER
Provider Business Practice Location Address City Name:
MT PLEASANT
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15666-1992
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-542-9792
Provider Business Practice Location Address Fax Number:
724-542-9793
Provider Enumeration Date:
05/06/2010

Additional Information

Authorized Official

Authorized Official Last Name:
BASTAICH
Authorized Official First Name:
YOLANDA
Authorized Official Middle Name:
A
Authorized Official Title or Position:
OPTOMETRIST
Authorized Official Telephone Number:
724-518-6263

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  OE008327T , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: U77385 . This is a "UPIN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com