Individual
SCOTT EDWARD BORGHOLTHAUS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD OPTOMETRIST
Contact information
Practice address
1867 1ST ST, CHENEY, WA 99004-1967
(509) 452-3937
(509) 453-6567
Mailing address
1867 1ST ST, CHENEY, WA 99004-1967
(509) 235-2010
(509) 235-2011
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
0736
ID
152W00000X
Optometrist
1812
OR
152W00000X
Optometrist
Primary
3218
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2028124
—
WA
01
—
815580
REGENCE BLUE SHIELD
WA
01
—
P00271493
PALMETTO GBA RAILROAD MED
—
Enumeration date
11/02/2006
Last updated
08/30/2017
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