Provider Demographics
NPI:1306920228
Name:BASTIN, ROBERT JOSEPH (OD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:JOSEPH
Last Name:BASTIN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1016 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HOPKINSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42240-2010
Mailing Address - Country:US
Mailing Address - Phone:270-886-2293
Mailing Address - Fax:270-886-0399
Practice Address - Street 1:1016 S MAIN ST
Practice Address - Street 2:
Practice Address - City:HOPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42240-2010
Practice Address - Country:US
Practice Address - Phone:270-886-2293
Practice Address - Fax:270-886-0399
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1164DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000049356OtherBC/BS
KY77011641Medicaid
KYU02586Medicare UPIN
KY9296801Medicare PIN