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General NPI Number Information
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NPI Number | 1578667283
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Entity Type | Organization
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Legal Business Name | LORI B BIRNDORF DO A MEDICAL CORPORATION
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Dates
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Enumeration Date | 09/12/2006
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Last Update Date | 03/22/2018
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Provider Practice Location Address
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Address Line | 425 W BONITA AVE STE 110
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City | SAN DIMAS
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State | CA
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Zip | 91773-2543
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Country | US
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Telephone | 909-599-0981
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Fax | 909-592-0738
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Provider Business Mailing Address
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Address Line | 9643 SHOUP AVE
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City | CHATSWORTH
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State | CA
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Zip | 91311-4720
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Country | US
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Telephone | 310-621-0878
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Fax | 818-763-2331
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Authorized Official
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Title or Position | PRESIDENT/OPHTHALMOLOGIST
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Name | LORI BETH BIRNDORF
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Credential | D.O.
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Telephone | 310-621-0878
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 20A6178
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License Number State | CA
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