Healthcare Provider Details

I. General information

NPI: 1356312821
Provider Name (Legal Business Name): RICHARD A BORGHI OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2006
Last Update Date: 03/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6049 DOUGLAS BLVD SUITE 23
GRANITE BAY CA
95746-6284
US

IV. Provider business mailing address

6049 DOUGLAS BLVD SUITE 23
GRANITE BAY CA
95746-6284
US

V. Phone/Fax

Practice location:
  • Phone: 916-791-3388
  • Fax: 916-791-1124
Mailing address:
  • Phone: 916-791-3388
  • Fax: 916-791-1124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WX0102X
TaxonomyOccupational Vision Optometrist
License Number7138T
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: