Provider Demographics
NPI:1063838274
Name:BASTIN, JOSEPH CORY (OD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:CORY
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?:No
Enumeration Date:2014-03-12
Last Update Date:2014-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1944DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist