Provider Demographics
NPI:1578569331
Name:PHILLIPS-BORSTAD, LEILANI MICHELLE (OD)
Entity Type:Individual
Prefix:DR
First Name:LEILANI
Middle Name:MICHELLE
Last Name:PHILLIPS-BORSTAD
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5104 S FIELD ST
Mailing Address - Street 2:STE. C
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80123-7329
Mailing Address - Country:US
Mailing Address - Phone:303-979-3937
Mailing Address - Fax:866-881-3396
Practice Address - Street 1:5104 S FIELD ST
Practice Address - Street 2:STE C
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80123-7308
Practice Address - Country:US
Practice Address - Phone:303-979-3937
Practice Address - Fax:866-881-3396
Is Sole Proprietor?:No
Enumeration Date:2005-06-24
Last Update Date:2009-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2135152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCO2135OtherEYEMED
CO920370OtherBLOCK
CO805234OtherMEDICARE GROUP
CO82677824Medicaid
CO5178222OtherCIGNA
CO805234OtherMEDICARE GROUP
COCO2135OtherEYEMED
CO6136530001Medicare NSC