Individual provider Active NPI

Rafael Agustin Borges, O.D.

  • Optometrist
  • Orlando, FL
National Provider Identifier
1477638633
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
2978 Issued in FL
Practice address
12548 Lake Underhill Rd
Orlando, FL 32828-7115
Phone
(407) 273-0002
Fax
(407) 273-7911
NPI assigned
Oct 26, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 2978 FL Primary
Optometrist 152W00000X 2433 MN

Addresses

Primary practice location

12548 Lake Underhill Rd
Orlando, FL 32828-7115

Mailing address

12548 Lake Underhill Rd
Orlando, FL 32828-7115
Phone (407) 273-0002

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110428000375 MN Practitioner - Optometry 5092815068 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Ferris State College - College of Optometry, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
MSP Eye Associates IncGroup PAC ID 1557496684, 2 clinicians

Practice addresses (Care Compare)

2020 Commerce Dr NW
Rochester, MN 55901-3246
Phone (507) 286-1874

7070 Tamarack Rd
Woodbury, MN 55125-1205
Phone (612) 540-5473

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2978FLMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
MSP Eye Associates Inc Optometrist CurrentSince Feb 1, 2011 Accepting new patients

Locations

2020 Commerce Dr NW
Rochester, MN 55901
Phone (507) 286-1870

7070 Tamarack Rd
Woodbury, MN 55125
Phone (612) 540-5458

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161820800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1477638633",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12548 LAKE UNDERHILL RD",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328287115",
            "telephone_number": "407-273-0002",
            "fax_number": "407-273-7911"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12548 LAKE UNDERHILL RD",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328287115",
            "telephone_number": "407-273-0002",
            "fax_number": "407-273-7911"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BORGES",
        "first_name": "RAFAEL",
        "middle_name": "AGUSTIN",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-26",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "FL",
            "license": "2978",
            "primary": true
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MN",
            "license": "2433",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Orlando, FL

Sources for this page

Verify at the official NPI Registry.