Healthcare Provider Details

I. General information

NPI: 1104139104
Provider Name (Legal Business Name): FAITH ENFIELD O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2010
Last Update Date: 03/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2150 N WATERMAN AVE STE 201
SAN BERNARDINO CA
92404-4811
US

IV. Provider business mailing address

2150 N WATERMAN AVE STE 201
SAN BERNARDINO CA
92404-4811
US

V. Phone/Fax

Practice location:
  • Phone: 805-801-9967
  • Fax:
Mailing address:
  • Phone: 805-801-9967
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number13942
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: