Healthcare Provider Details

I. General information

NPI: 1255501946
Provider Name (Legal Business Name): UMATILLA OPTICAL AND HEARING AID CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2008
Last Update Date: 03/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

570 HATFIELD DR
UMATILLA FL
32784-8986
US

IV. Provider business mailing address

570 HATFIELD DR
UMATILLA FL
32784-8986
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License NumberFL3146
License Number StateFL

VIII. Authorized Official

Name: KATHLEEN BASTONE
Title or Position: OWNER/PRESIDENT
Credential:
Phone: 352-669-6888