Provider Demographics
NPI:1578667283
Name:LORI B BIRNDORF DO A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:LORI B BIRNDORF DO A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OPHTHALMOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:BIRNDORF
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:310-621-0878
Mailing Address - Street 1:9643 SHOUP AVE
Mailing Address - Street 2:
Mailing Address - City:CHATSWORTH
Mailing Address - State:CA
Mailing Address - Zip Code:91311-4720
Mailing Address - Country:US
Mailing Address - Phone:310-621-0878
Mailing Address - Fax:818-763-2331
Practice Address - Street 1:425 W BONITA AVE STE 110
Practice Address - Street 2:
Practice Address - City:SAN DIMAS
Practice Address - State:CA
Practice Address - Zip Code:91773-2543
Practice Address - Country:US
Practice Address - Phone:909-599-0981
Practice Address - Fax:909-592-0738
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-12
Last Update Date:2018-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A6178207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX61780Medicaid
CAP00106907OtherPALMETTO GBA
CA00AX61781Medicaid
CA00AX61780Medicaid
G11287Medicare UPIN
CA00AX61781Medicaid
CAW20A6178LMedicare PIN