Bastian Eyecare Professionals
Optometrist in Medford, MA. Organization (NPI-2).
NPI number1508243239
StatusActive
Last updated in NPPESMay 1, 2015
Details
- NPI
- 1508243239
- Entity type
- Organization (NPI-2)
- Legal business name
- Bastian Eyecare Professionals
- Organization subpart
- No
- Enumeration date
- May 1, 2015
- Last updated
- May 1, 2015
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 152W00000X | Optometrist | – | – | Yes |
Practice location
12 Revere PlMedford, MA 02155-3903
Phone 508-517-0865
Mailing address
12 Revere PlMedford, MA 02155-3903
Phone 508-517-0865
Authorized official
Daniel Bastian
Optometrist
5085170865
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