Provider Demographics
NPI:1477336329
Name:BASTA, CAROLINE YARGO (OD)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:YARGO
Last Name:BASTA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6242 ARCTIC LOON WAY
Mailing Address - Street 2:
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95765-4778
Mailing Address - Country:US
Mailing Address - Phone:916-741-1400
Mailing Address - Fax:
Practice Address - Street 1:2100 ARDEN WAY STE 103
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-2216
Practice Address - Country:US
Practice Address - Phone:279-214-0185
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-15
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35574152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist