Provider Demographics
NPI:1861425035
Name:BASILE, KATHLEEN ANN (OD)
Entity type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:ANN
Last Name:BASILE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:888 WORCESTER ST
Mailing Address - Street 2:SUITE 130
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02482-3744
Mailing Address - Country:US
Mailing Address - Phone:617-964-6681
Mailing Address - Fax:339-686-2561
Practice Address - Street 1:888 WORCESTER ST
Practice Address - Street 2:SUITE 130
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02482-3744
Practice Address - Country:US
Practice Address - Phone:617-964-6681
Practice Address - Fax:339-686-2561
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA3573152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0356018Medicaid
MA410045312OtherMEDICARE RAILROAD
MAW15836OtherBLUE CROSS BLUE SHIELD
MA410045312OtherMEDICARE RAILROAD
MA0356018Medicaid