Organization
UMATILLA OPTICAL & HEARING AID CENTER INC
Active
Other names
Kathleen Bastone
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KATHLEEN BASTONE LDO (OWNER)
(352) 669-6888
Entity
Organization
Contact information
Practice address
570 HATFIELD DR, UMATILLA, FL 32784-8986
(352) 669-6888
(352) 669-1015
Mailing address
570 HATFIELD DR, UMATILLA, FL 32784-8986
(352) 669-6888
(352) 669-1015
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
DO3146
FL
332S00000X
Hearing Aid Equipment
AS2700
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0647230001
MEDICARE P TAN NUMBER
FL
05
—
086623700
—
FL
05
—
086623701
—
FL
01
—
10449
CMS PEDICARE
FL
01
—
2100002
UHC
FL
05
—
610136400
—
FL
01
—
FL3146
EYEMED
FL
Enumeration date
02/06/2008
Last updated
03/19/2015
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