Individual
KATHLEEN BASTONE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
570 HATFIELD DR, UMATILLA, FL 32784-8986
(352) 669-6888
Mailing address
17200 PERU RD, UMATILLA, FL 32784-9359
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
—
—
237700000X
Hearing Instrument Specialist
AS2700
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
086623700
—
FL
05
—
086623701
—
FL
01
—
2100002
UNITED HEALTHCARE
FL
01
—
593024353
I.D. NUMBER
FL
05
—
610136400
—
FL
01
—
FL3146
EYE MED
FL
Enumeration date
09/02/2006
Last updated
03/05/2008
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