Provider Demographics
NPI:1013255959
Name:STEPHEN G BORNFELD OD INC
Entity Type:Organization
Organization Name:STEPHEN G BORNFELD OD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:G
Authorized Official - Last Name:BORNFELD
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:626-446-2122
Mailing Address - Street 1:622 W DUARTE RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91007-7606
Mailing Address - Country:US
Mailing Address - Phone:626-446-2122
Mailing Address - Fax:626-446-0513
Practice Address - Street 1:622 W DUARTE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91007-7606
Practice Address - Country:US
Practice Address - Phone:626-446-2122
Practice Address - Fax:626-446-0513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-28
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT 5505 TPL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0055050Medicaid
CA410044000Medicare PIN
CAU70251Medicare UPIN
CAOP5505Medicare PIN