Provider Demographics
NPI:1558432633
Name:HORNSTEIN, BRUCE ALLEN (OD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:ALLEN
Last Name:HORNSTEIN
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 1:330 N BRAND BLVD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91203-2308
Mailing Address - Country:US
Mailing Address - Phone:818-956-7899
Mailing Address - Fax:818-241-0468
Practice Address - Street 1:330 N BRAND BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-2308
Practice Address - Country:US
Practice Address - Phone:818-956-7899
Practice Address - Fax:818-241-0468
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-12
Last Update Date:2012-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT 7814 TPG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4227033OtherAETNA PROVIDER ID
CA910940OtherEYEMED COLE VISION ID
CA1558432633Medicaid
CAOP7814Medicare ID - Type UnspecifiedMEDICARE ID NUMBER
CA4227033OtherAETNA PROVIDER ID