Healthcare Provider Details

I. General information

NPI: 1013019603
Provider Name (Legal Business Name): KATHLEEN BASTONE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2006
Last Update Date: 03/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

570 HATFIELD DR
UMATILLA FL
32784-8986
US

IV. Provider business mailing address

17200 PERU RD
UMATILLA FL
32784-9359
US

V. Phone/Fax

Practice location:
  • Phone: 352-669-6888
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberAS2700
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: