Provider Demographics
NPI:1639205339
Name:R. L. BORCHERDING OD PLC
Entity Type:Organization
Organization Name:R. L. BORCHERDING OD PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:L
Authorized Official - Last Name:BORCHERDING
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:563-355-1163
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:
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01611152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI16660Medicare ID - Type Unspecified