Individual
DR. JAY LESLIE BORGHOLTHAUS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
301 S 4TH AVE # C-2, POCATELLO, ID 83201-6462
(208) 637-0841
(208) 237-6922
Mailing address
301 S 4TH AVE # C-2, POCATELLO, ID 83201-6462
(208) 637-0841
(208) 237-6922
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
ODP-865
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000308200
—
ID
Enumeration date
05/17/2006
Last updated
06/22/2016
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