MEDICARE: ELIZABETH M BORZA OD INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	0618002034	VA

General Provider Information

NPI Number	:	1942550231
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELIZABETH M BORZA OD INC

Provider Business Mailing Address
First Line	:	2201 UPTON DR
Second Line	:	902
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23454-1292
Country	:	US
Telephone Number	:	757-430-2863
Fax Number	:	757-430-2865

Provider Business Practice Location Address
First Line	:	2201 UPTON DR
Second Line	:	902
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23454-1292
Country	:	US
Telephone Number	:	757-430-2863
Fax Number	:	757-430-2865

Authorized Official
Title or Position	:	OWNER
Name	:	ELIZABETH BORZA
Credential	:	OD
Telephone Number	:	757-430-2863

Provider Enumeration Date	:	09/13/2012
Last Update Date	:	03/21/2013

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