MEDICARE: DR. ROBERT BASTAICH & ASSOC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	0618001635	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770777914
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. ROBERT BASTAICH & ASSOC.

Provider Business Mailing Address
First Line	:	2501 SHEILA LN
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23225-2041
Country	:	US
Telephone Number	:	804-320-9457
Fax Number	:	804-320-9458

Provider Business Practice Location Address
First Line	:	2501 SHEILA LN
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23225-2041
Country	:	US
Telephone Number	:	804-320-9457
Fax Number	:	804-320-9458

Authorized Official
Title or Position	:	OPTOMETRIST
Name	:	DR. ROBERT BASTAICH
Credential	:	O.D.
Telephone Number	:	804-320-9457

Provider Enumeration Date	:	08/30/2007
Last Update Date	:	08/30/2007

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