Provider Demographics
NPI:1396783130
Name:BLUMENFELD, LOUIS C (MD)
Entity type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:C
Last Name:BLUMENFELD
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1033 DR MARTIN LUTHER KING JR ST N
Mailing Address - Street 2:SUITE 108
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-1547
Mailing Address - Country:US
Mailing Address - Phone:727-456-4250
Mailing Address - Fax:727-346-1044
Practice Address - Street 1:790 CONCOURSE PKWY S
Practice Address - Street 2:SUITE 200
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751
Practice Address - Country:US
Practice Address - Phone:407-767-6411
Practice Address - Fax:407-767-8160
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2020-09-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME069139207WX0109X, 207W00000X, 207WX0110X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0110XAllopathic & Osteopathic PhysiciansOphthalmologyPediatric Ophthalmology and Strabismus Specialist
No207WX0109XAllopathic & Osteopathic PhysiciansOphthalmologyNeuro-ophthalmology
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL250233000Medicaid
FL28961UMedicare PIN
FL1125956Medicare PIN
FL250233000Medicaid
FLP00006693Medicare PIN
FL28961WMedicare PIN
FLG25377Medicare UPIN