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General NPI Number Information
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NPI Number | 1841478484
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Entity Type | Organization
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Legal Business Name | UMATILLA OPTICAL & HEARING AID CENTER INC
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Dates
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Enumeration Date | 02/06/2008
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Last Update Date | 03/19/2015
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Provider Practice Location Address
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Address Line | 570 HATFIELD DR
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City | UMATILLA
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State | FL
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Zip | 32784-8986
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Country | US
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Telephone | 352-669-6888
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Fax | 352-669-1015
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Provider Business Mailing Address
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Address Line | 570 HATFIELD DR
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City | UMATILLA
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State | FL
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Zip | 32784-8986
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Country | US
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Telephone | 352-669-6888
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Fax | 352-669-1015
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Authorized Official
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Title or Position | OWNER
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Name | MRS. KATHLEEN BASTONE
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Credential | LDO
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Telephone | 352-669-6888
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332S00000X
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Taxonomy Name | Hearing Aid Equipment
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License Number | AS2700
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | DO3146
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License Number State | FL
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