Provider Demographics
NPI:1780897942
Name:BONFIGLIO, ADOLPHE
Entity type:Individual
Prefix:
First Name:ADOLPHE
Middle Name:
Last Name:BONFIGLIO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9190 SW PARKVIEW LOOP
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97008-7304
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12100 SE STEVENS CT STE 106
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97266-8707
Practice Address - Country:US
Practice Address - Phone:503-353-7300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1202XEye and Vision Services ProvidersTechnician/TechnologistOptometric Technician