Provider Demographics
NPI:1245388933
Name:BAZIN OPTOMETRY, P.C.
Entity Type:Organization
Organization Name:BAZIN OPTOMETRY, P.C.
Other - Org Name:VISION DEVELOPMENT ASSOC., INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:M.
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:BAZIN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:816-333-1500
Mailing Address - Street 1:1441 E 104TH ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64131-4634
Mailing Address - Country:US
Mailing Address - Phone:816-333-1500
Mailing Address - Fax:816-943-0885
Practice Address - Street 1:1441 E 104TH ST
Practice Address - Street 2:SUITE 103
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64131-4634
Practice Address - Country:US
Practice Address - Phone:816-333-1500
Practice Address - Fax:816-943-0885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOT03320152W00000X, 152WL0500X, 152WP0200X, 152WV0400X, 152WX0102X
MOT03220152WS0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Not Answered152WL0500XEye and Vision Services ProvidersOptometristLow Vision RehabilitationGroup - Single Specialty
Not Answered152WP0200XEye and Vision Services ProvidersOptometristPediatricsGroup - Single Specialty
Not Answered152WS0006XEye and Vision Services ProvidersOptometristSports VisionGroup - Single Specialty
Not Answered152WV0400XEye and Vision Services ProvidersOptometristVision TherapyGroup - Single Specialty
Not Answered152WX0102XEye and Vision Services ProvidersOptometristOccupational VisionGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOU65051Medicare UPIN