Provider Demographics
NPI:1356312821
Name:BORGHI, RICHARD A (OD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:A
Last Name:BORGHI
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6049 DOUGLAS BLVD
Mailing Address - Street 2:SUITE 23
Mailing Address - City:GRANITE BAY
Mailing Address - State:CA
Mailing Address - Zip Code:95746-6284
Mailing Address - Country:US
Mailing Address - Phone:916-791-3388
Mailing Address - Fax:916-791-1124
Practice Address - Street 1:6049 DOUGLAS BLVD
Practice Address - Street 2:SUITE 23
Practice Address - City:GRANITE BAY
Practice Address - State:CA
Practice Address - Zip Code:95746-6284
Practice Address - Country:US
Practice Address - Phone:916-791-3388
Practice Address - Fax:916-791-1124
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-31
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7138T152WX0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4784980001Medicare NSC
CASD0071380Medicare PIN