Provider Demographics
NPI:1811902257
Name:BASICH, FRANK M (MD)
Entity type:Individual
Prefix:DR
First Name:FRANK
Middle Name:M
Last Name:BASICH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:234 HEATHER CT
Mailing Address - Street 2:SUITE 102
Mailing Address - City:TEMPLETON
Mailing Address - State:CA
Mailing Address - Zip Code:93465-8765
Mailing Address - Country:US
Mailing Address - Phone:805-434-5970
Mailing Address - Fax:805-434-5973
Practice Address - Street 1:234 HEATHER CT
Practice Address - Street 2:SUITE 102
Practice Address - City:TEMPLETON
Practice Address - State:CA
Practice Address - Zip Code:93465
Practice Address - Country:US
Practice Address - Phone:805-434-5970
Practice Address - Fax:805-434-5973
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2018-08-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG070463207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G704630Medicaid
CA00G704630Medicaid
CAWG70463DMedicare ID - Type Unspecified
CA180032071Medicare ID - Type UnspecifiedRR MEDICARE
CAWG70463CMedicare ID - Type Unspecified