Provider Demographics
NPI:1790849933
Name:BAY OPTICAL INC
Entity Type:Organization
Organization Name:BAY OPTICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:G
Authorized Official - Last Name:BASTHOLM
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:302-645-2220
Mailing Address - Street 1:1540 SAVANNAH ROAD
Mailing Address - Street 2:SUITE B
Mailing Address - City:LEWES
Mailing Address - State:DE
Mailing Address - Zip Code:19958
Mailing Address - Country:US
Mailing Address - Phone:302-645-2220
Mailing Address - Fax:302-645-2290
Practice Address - Street 1:1540 SAVANNAH ROAD
Practice Address - Street 2:SUITE B
Practice Address - City:LEWES
Practice Address - State:DE
Practice Address - Zip Code:19958
Practice Address - Country:US
Practice Address - Phone:302-645-2220
Practice Address - Fax:302-645-2290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DET26919156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0211670001Medicare UPIN