Provider Demographics
NPI:1124014527
Name:BORCHERDING, RONALD LESLIE (OD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:LESLIE
Last Name:BORCHERDING
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 WILDWOOD TRL
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-3871
Mailing Address - Country:US
Mailing Address - Phone:563-355-1163
Mailing Address - Fax:563-359-8641
Practice Address - Street 1:3101 W KIMBERLY RD
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52806-3400
Practice Address - Country:US
Practice Address - Phone:563-445-0152
Practice Address - Fax:563-445-0578
Is Sole Proprietor?:No
Enumeration Date:2005-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01611152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1433664Medicaid
T12282Medicare UPIN
IA1433664Medicaid