Provider Demographics
NPI:1891906707
Name:DINSMORE, STEPHEN C (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:C
Last Name:DINSMORE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19000 HAWTHORNE BLVD
Mailing Address - Street 2:110
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-1517
Mailing Address - Country:US
Mailing Address - Phone:310-370-3628
Mailing Address - Fax:310-371-7863
Practice Address - Street 1:19000 HAWTHORNE BLVD
Practice Address - Street 2:#110
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-1517
Practice Address - Country:US
Practice Address - Phone:310-370-3628
Practice Address - Fax:310-371-7863
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAWG32005207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
A44952Medicare UPIN
CAWG32005BMedicare PIN
CAWG32005AMedicare PIN