Provider Demographics
NPI:1780065011
Name:BORGESON, CATHERINE (OD)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:BORGESON
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 1:155 WINTER GARDEN VINELAND ROAD
Mailing Address - Street 2:102
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787
Mailing Address - Country:US
Mailing Address - Phone:407-656-3755
Mailing Address - Fax:407-656-5362
Practice Address - Street 1:1155 WINTER GARDEN VINELAND RD
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-4375
Practice Address - Country:US
Practice Address - Phone:407-656-3755
Practice Address - Fax:407-656-5362
Is Sole Proprietor?:No
Enumeration Date:2015-06-11
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC5111152W00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes152W00000XEye and Vision Services ProvidersOptometrist