Provider Demographics
NPI:1427097344
Name:BORGOGNONI, ANTHONY PETER (OD)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:PETER
Last Name:BORGOGNONI
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3307 WELLS DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-6634
Mailing Address - Country:US
Mailing Address - Phone:214-718-4848
Mailing Address - Fax:
Practice Address - Street 1:1900 PRESTON RD
Practice Address - Street 2:SUITE 265
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-5175
Practice Address - Country:US
Practice Address - Phone:972-519-0006
Practice Address - Fax:972-519-0669
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3409TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
60103017OtherDPS
TX100742901OtherMEDICAID
TX100742901OtherMEDICAID
TX100742901OtherMEDICAID