Provider Demographics
NPI:1548219348
Name:BORSKY, TOMAS
Entity Type:Individual
Prefix:
First Name:TOMAS
Middle Name:
Last Name:BORSKY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:154 HUGHES RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-5630
Mailing Address - Country:US
Mailing Address - Phone:530-272-2238
Mailing Address - Fax:530-272-1623
Practice Address - Street 1:154 HUGHES RD
Practice Address - Street 2:SUITE 3
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-5630
Practice Address - Country:US
Practice Address - Phone:530-272-2238
Practice Address - Fax:530-272-1623
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-09
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT9518TPA152W00000X
CO1432152W00000X
MOD02768152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0095180Medicaid
CA0645160001Medicare NSC
CAU41758Medicare UPIN
CASD0095180Medicaid