1578569331 NPI number — DR. LEILANI MICHELLE PHILLIPS-BORSTAD O.D.

Table of content: DR. LEILANI MICHELLE PHILLIPS-BORSTAD O.D. (NPI 1578569331)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578569331 NPI number — DR. LEILANI MICHELLE PHILLIPS-BORSTAD O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PHILLIPS-BORSTAD
Provider First Name:
LEILANI
Provider Middle Name:
MICHELLE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1578569331
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/09/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5104 S FIELD ST
Provider Second Line Business Mailing Address:
STE. C
Provider Business Mailing Address City Name:
LITTLETON
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80123-7329
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-979-3937
Provider Business Mailing Address Fax Number:
866-881-3396

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5104 S FIELD ST
Provider Second Line Business Practice Location Address:
STE C
Provider Business Practice Location Address City Name:
LITTLETON
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80123-7308
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-979-3937
Provider Business Practice Location Address Fax Number:
866-881-3396
Provider Enumeration Date:
06/24/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  2135 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: CO2135 . This is a "EYEMED" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 920370 . This is a "BLOCK" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 805234 . This is a "MEDICARE GROUP" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 82677824 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5178222 . This is a "CIGNA" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".




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