Provider Demographics
NPI:1477638633
Name:BORGES, RAFAEL AGUSTIN (OD)
Entity Type:Individual
Prefix:DR
First Name:RAFAEL
Middle Name:AGUSTIN
Last Name:BORGES
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 1:12548 LAKE UNDERHILL RD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-7115
Mailing Address - Country:US
Mailing Address - Phone:407-273-0002
Mailing Address - Fax:407-273-7911
Practice Address - Street 1:12548 LAKE UNDERHILL RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-7115
Practice Address - Country:US
Practice Address - Phone:407-273-0002
Practice Address - Fax:407-273-7911
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2978152W00000X
MN2433152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNU44180Medicare UPIN