NPIMap

Organization Active NPI

Bastian Eyecare Professionals

  • Optometrist
  • Medford, MA
National Provider Identifier
1508243239
Registry record updated May 1, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
BASTIAN EYECARE PROFESSIONALS
Practice address
12 Revere PL
Medford, MA 02155-3903
Phone
(508) 517-0865
NPI assigned
May 1, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 1, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Daniel Bastian, ODNPI 1770848384
Title
Optometrist
Phone
(508) 517-0865

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X Primary

Addresses

Primary practice location

12 Revere PL
Medford, MA 02155-3903

Mailing address

12 Revere PL
Medford, MA 02155-3903
Phone (508) 517-0865

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1430438400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1430438400000",
    "number": "1508243239",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12 REVERE PL",
            "city": "MEDFORD",
            "state": "MA",
            "postal_code": "021553903",
            "telephone_number": "508-517-0865"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12 REVERE PL",
            "city": "MEDFORD",
            "state": "MA",
            "postal_code": "021553903",
            "telephone_number": "508-517-0865"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BASTIAN EYECARE PROFESSIONALS",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-05-01",
        "last_updated": "2015-05-01",
        "status": "A",
        "authorized_official_last_name": "BASTIAN",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_title_or_position": "OPTOMETRIST",
        "authorized_official_telephone_number": "508-517-0865",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Medford, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.