Provider Demographics
NPI:1902931744
Name:BONFIGLIO, FREDERIC D (OPHTHALMIC DISPENSER)
Entity Type:Individual
Prefix:MR
First Name:FREDERIC
Middle Name:D
Last Name:BONFIGLIO
Suffix:
Gender:M
Credentials:OPHTHALMIC DISPENSER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:415 EGG HARBOR RD
Mailing Address - Street 2:SUITE 14
Mailing Address - City:SEWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:08080-9211
Mailing Address - Country:US
Mailing Address - Phone:856-589-2939
Mailing Address - Fax:856-589-5225
Practice Address - Street 1:415 EGG HARBOR RD
Practice Address - Street 2:SUITE 14
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080-9211
Practice Address - Country:US
Practice Address - Phone:856-589-2929
Practice Address - Fax:856-589-5225
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2008-12-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ31TD00070800156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician