Provider Demographics
NPI:1598763674
Name:LAFONT, ROBERT A (OD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:A
Last Name:LAFONT
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 1:7960 ORANGETHORPE AVE
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90621-3437
Mailing Address - Country:US
Mailing Address - Phone:714-521-3002
Mailing Address - Fax:714-521-1475
Practice Address - Street 1:7960 ORANGETHORPE AVE
Practice Address - Street 2:
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90621-3437
Practice Address - Country:US
Practice Address - Phone:714-521-3002
Practice Address - Fax:714-521-1475
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT06276T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPT06276TOtherOPTOMETRIC LICENSE
CAGSD005390Medicaid
CASD0062760Medicaid
CA0349700001Medicare NSC
CAT70103Medicare UPIN
CABT747AMedicare PIN