Basic Information
| Provider Information | |||||||||
| NPI: | 1902931744 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BONFIGLIO | ||||||||
| FirstName: | FREDERIC | ||||||||
| MiddleName: | D | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | OPHTHALMIC DISPENSER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 415 EGG HARBOR RD | ||||||||
| Address2: | SUITE 14 | ||||||||
| City: | SEWELL | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080809211 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8565892939 | ||||||||
| FaxNumber: | 8565895225 | ||||||||
| Practice Location | |||||||||
| Address1: | 415 EGG HARBOR RD | ||||||||
| Address2: | SUITE 14 | ||||||||
| City: | SEWELL | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080809211 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8565892929 | ||||||||
| FaxNumber: | 8565895225 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/22/2007 | ||||||||
| LastUpdateDate: | 12/11/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 156FX1800X | 31TD00070800 | NJ | Y | Eye and Vision Services Providers | Technician/Technologist | Optician |
No ID Information.