Provider Demographics
NPI:1861710410
Name:YOLANDA BASTAICH O.D.
Entity type:Organization
Organization Name:YOLANDA BASTAICH O.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:YOLANDA
Authorized Official - Middle Name:A
Authorized Official - Last Name:BASTAICH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:724-518-6263
Mailing Address - Street 1:104 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLEROI
Mailing Address - State:PA
Mailing Address - Zip Code:15022-1432
Mailing Address - Country:US
Mailing Address - Phone:724-518-6263
Mailing Address - Fax:
Practice Address - Street 1:2100 SUMMIT RIDGE PLZ
Practice Address - Street 2:WALMART VISION CENTER
Practice Address - City:MT PLEASANT
Practice Address - State:PA
Practice Address - Zip Code:15666-1992
Practice Address - Country:US
Practice Address - Phone:724-542-9792
Practice Address - Fax:724-542-9793
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-06
Last Update Date:2010-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOE008327T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU77385OtherUPIN