Provider Demographics
NPI:1114980620
Name:ERIC BATISTE OD INC
Entity Type:Organization
Organization Name:ERIC BATISTE OD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:S
Authorized Official - Last Name:BATISTE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:814-944-1492
Mailing Address - Street 1:1307 MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:DUNCANSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16635-7201
Mailing Address - Country:US
Mailing Address - Phone:814-944-1492
Mailing Address - Fax:814-944-7975
Practice Address - Street 1:J.C. PENNEY OPTICAL
Practice Address - Street 2:LOGAN VALLEY MALL
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602
Practice Address - Country:US
Practice Address - Phone:814-944-1492
Practice Address - Fax:814-944-7975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000080152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA056268Medicare ID - Type Unspecified