=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124045737
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHRISTOPHER J BORGEN OD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/17/2006
-----------------------------------------------------
Last Update Date | 06/01/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1720 HWY 59 SE SUITE 1 BOX 505
-----------------------------------------------------
City | THIEF RIVER FALLS
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 56701
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 218-681-3300
-----------------------------------------------------
Fax | 218-681-6733
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1720 HWY 59 SE SUITE 1 BOX 505
-----------------------------------------------------
City | THIEF RIVER FALLS
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 56701
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 218-681-3300
-----------------------------------------------------
Fax | 218-681-6733
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 2803
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------