Provider Demographics
NPI:1639433774
Name:BORBIDGE, JAMY VAN WYCK (OD)
Entity Type:Individual
Prefix:
First Name:JAMY
Middle Name:VAN WYCK
Last Name:BORBIDGE
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 1:11 WINDSOR RD
Mailing Address - Street 2:
Mailing Address - City:BOW
Mailing Address - State:NH
Mailing Address - Zip Code:03304-5218
Mailing Address - Country:US
Mailing Address - Phone:603-568-9257
Mailing Address - Fax:
Practice Address - Street 1:2043 COLLEGE WAY
Practice Address - Street 2:
Practice Address - City:FOREST GROVE
Practice Address - State:OR
Practice Address - Zip Code:97116-1756
Practice Address - Country:US
Practice Address - Phone:503-352-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-03
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4993152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist