Provider Demographics
NPI:1518085208
Name:FADER, MILTON (OD)
Entity Type:Individual
Prefix:DR
First Name:MILTON
Middle Name:
Last Name:FADER
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 1:8331 FIRESTONE BLVD
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90241-3841
Mailing Address - Country:US
Mailing Address - Phone:562-923-9218
Mailing Address - Fax:562-923-4345
Practice Address - Street 1:8331 FIRESTONE BLVD
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90241-3841
Practice Address - Country:US
Practice Address - Phone:562-923-9218
Practice Address - Fax:562-923-4345
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA 5080 TPA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0140OtherVISION PLAN OF AMERICA
CA4752OtherCARE 1ST
CA03168OtherMEDICAL EYE SERVICE
CA1733OtherHEALTH NET
CAMF06054OtherSPECTERA
CA2504OtherGOLDEN WEST
CA2505OtherDAVIS VISION
CACA5080OtherEYE MED
CASD0050801Medicaid
CAMF06054OtherSPECTERA