Provider Demographics
NPI:1689767626
Name:BASKETT, JOHN S (OD)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:S
Last Name:BASKETT
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:1151 GALLERIA BLVD STE 240
Mailing Address - Street 2:C/O EYE DESIGNS OPTOMETRY
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95678-1944
Mailing Address - Country:US
Mailing Address - Phone:916-772-3937
Mailing Address - Fax:916-772-4779
Practice Address - Street 1:1151 GALLERIA BLVD STE 240
Practice Address - Street 2:C/O EYE DESIGNS OPTOMETRY
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95678-1944
Practice Address - Country:US
Practice Address - Phone:916-772-3937
Practice Address - Fax:916-772-4779
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA8423T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU13837Medicare UPIN
CASDO084230Medicare ID - Type Unspecified