Provider Demographics
NPI:1346314416
Name:STOLPE, CAROLE LEWIS (BCO)
Entity Type:Individual
Prefix:
First Name:CAROLE
Middle Name:LEWIS
Last Name:STOLPE
Suffix:
Gender:F
Credentials:BCO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:435 N BEDFORD DR
Mailing Address - Street 2:SUITE 411
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-4321
Mailing Address - Country:US
Mailing Address - Phone:310-271-8801
Mailing Address - Fax:310-271-6189
Practice Address - Street 1:435 N BEDFORD DR
Practice Address - Street 2:SUITE 411
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4321
Practice Address - Country:US
Practice Address - Phone:310-271-8801
Practice Address - Fax:310-271-6189
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2008-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA89-227-07156FX1700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1700XEye and Vision Services ProvidersTechnician/TechnologistOcularist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADX0899010Medicaid
CA6105500001Medicare NSC