Provider Demographics
NPI:1235266131
Name:BORNFELD, STEPHEN G (OD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:G
Last Name:BORNFELD
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:622 W DUARTE RD
Mailing Address - Street 2:101
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91007-7606
Mailing Address - Country:US
Mailing Address - Phone:626-446-2122
Mailing Address - Fax:626-446-0513
Practice Address - Street 1:622 W DUARTE RD
Practice Address - Street 2:101
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91007-7606
Practice Address - Country:US
Practice Address - Phone:626-446-2122
Practice Address - Fax:626-446-0513
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2013-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT5505152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0055050OtherBLUE SHILED
CASD0055050Medicaid
CA410044000Medicare PIN
CASD0055050Medicaid
CASD0055050OtherBLUE SHILED