=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659133262
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SALICIA COLLEEN BORGES
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/29/2024
-----------------------------------------------------
Last Update Date | 08/06/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1844 BROADWATER AVE STE 5
-----------------------------------------------------
City | BILLINGS
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59102-4875
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-797-2020
-----------------------------------------------------
Fax | 406-797-7227
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1844 BROADWATER AVE STE 5
-----------------------------------------------------
City | BILLINGS
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59102-4875
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-797-2020
-----------------------------------------------------
Fax | 406-797-7227
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332H00000X
-----------------------------------------------------
Taxonomy Name | Eyewear Supplier
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 156FX1800X
-----------------------------------------------------
Taxonomy Name | Optician
-----------------------------------------------------
License Number | 227292
-----------------------------------------------------
License Number State | MT
-----------------------------------------------------