Provider Demographics
NPI:1013005917
Name:BOIWKA, ROMAN (OD)
Entity Type:Individual
Prefix:DR
First Name:ROMAN
Middle Name:
Last Name:BOIWKA
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 1:235 SLEEPY HOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:OH
Mailing Address - Zip Code:44001-3430
Mailing Address - Country:US
Mailing Address - Phone:440-988-9235
Mailing Address - Fax:
Practice Address - Street 1:35901 CHESTER RD
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:OH
Practice Address - Zip Code:44011-1069
Practice Address - Country:US
Practice Address - Phone:440-937-4765
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3982 / T366152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist