Basic Information
| Provider Information | |||||||||
| NPI: | 1992952865 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BASTON | ||||||||
| FirstName: | CATHERINE | ||||||||
| MiddleName: | ELIZABETH | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1290 | ||||||||
| Address2: | |||||||||
| City: | FOREST | ||||||||
| State: | VA | ||||||||
| PostalCode: | 245511290 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4343855600 | ||||||||
| FaxNumber: | 4344557172 | ||||||||
| Practice Location | |||||||||
| Address1: | 1825 GRAVES MILL RD | ||||||||
| Address2: | |||||||||
| City: | FOREST | ||||||||
| State: | VA | ||||||||
| PostalCode: | 245513967 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4343855600 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/22/2008 | ||||||||
| LastUpdateDate: | 04/20/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/20/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | 35272 | SC | N | Allopathic & Osteopathic Physicians | Ophthalmology | 207W00000X | 0101268706 | VA | Y | Allopathic & Osteopathic Physicians | Ophthalmology |
ID Information
| ID | Type | State | Issuer | Description | P01134421 | 01 | SC | RAILROAD MEDICARE | OTHER | 352727 | 05 | SC | MEDICAID |