Provider Demographics
NPI:1255501946
Name:UMATILLA OPTICAL AND HEARING AID CENTER, INC
Entity type:Organization
Organization Name:UMATILLA OPTICAL AND HEARING AID CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BASTONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-669-6888
Mailing Address - Street 1:570 HATFIELD DR
Mailing Address - Street 2:
Mailing Address - City:UMATILLA
Mailing Address - State:FL
Mailing Address - Zip Code:32784-8986
Mailing Address - Country:US
Mailing Address - Phone:352-669-6888
Mailing Address - Fax:
Practice Address - Street 1:570 HATFIELD DR
Practice Address - Street 2:
Practice Address - City:UMATILLA
Practice Address - State:FL
Practice Address - Zip Code:32784-8986
Practice Address - Country:US
Practice Address - Phone:352-669-6888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-10
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFL3146156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0647230001Medicare NSC