Healthcare Provider Details

I. General information

NPI: 1013255959
Provider Name (Legal Business Name): STEPHEN G BORNFELD OD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2013
Last Update Date: 01/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

622 W DUARTE RD SUITE 101
ARCADIA CA
91007-7606
US

IV. Provider business mailing address

622 W DUARTE RD SUITE 101
ARCADIA CA
91007-7606
US

V. Phone/Fax

Practice location:
  • Phone: 626-446-2122
  • Fax: 626-446-0513
Mailing address:
  • Phone: 626-446-2122
  • Fax: 626-446-0513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT 5505 TPL
License Number StateCA

VIII. Authorized Official

Name: STEPHEN G BORNFELD
Title or Position: PRESIDENT
Credential: O.D.
Phone: 626-446-2122