1518085208 NPI number — DR. MILTON FADER O.D

Table of content: DR. MILTON FADER O.D (NPI 1518085208)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518085208 NPI number — DR. MILTON FADER O.D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FADER
Provider First Name:
MILTON
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
O.D
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1518085208
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8331 FIRESTONE BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DOWNEY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90241-3841
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
562-923-9218
Provider Business Mailing Address Fax Number:
562-923-4345

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8331 FIRESTONE BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DOWNEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90241-3841
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-923-9218
Provider Business Practice Location Address Fax Number:
562-923-4345
Provider Enumeration Date:
03/27/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  CA 5080 TPA , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0140 . This is a "VISION PLAN OF AMERICA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 4752 . This is a "CARE 1ST" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 03168 . This is a "MEDICAL EYE SERVICE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 1733 . This is a "HEALTH NET" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: MF06054 . This is a "SPECTERA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 2504 . This is a "GOLDEN WEST" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 2505 . This is a "DAVIS VISION" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: CA5080 . This is a "EYE MED" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: SD0050801 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com