Provider Demographics
NPI:1659133262
Name:BORGES, SALICIA COLLEEN
Entity Type:Individual
Prefix:
First Name:SALICIA
Middle Name:COLLEEN
Last Name:BORGES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:928 BROADWATER AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59101-2700
Mailing Address - Country:US
Mailing Address - Phone:406-797-2020
Mailing Address - Fax:406-797-7227
Practice Address - Street 1:928 BROADWATER AVE STE 103
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101-2700
Practice Address - Country:US
Practice Address - Phone:406-797-2020
Practice Address - Fax:406-797-7227
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-29
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332H00000X
MT227292156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty
No332H00000XSuppliersEyewear Supplier