Provider Demographics
NPI:1033880851
Name:BOYD, EMMALENA ANN (OD)
Entity Type:Individual
Prefix:
First Name:EMMALENA
Middle Name:ANN
Last Name:BOYD
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:EMMALENA
Other - Middle Name:ANN
Other - Last Name:ILLIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7275 ADOBE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:KELSEYVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95451-8008
Mailing Address - Country:US
Mailing Address - Phone:707-350-5740
Mailing Address - Fax:
Practice Address - Street 1:225 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LAKEPORT
Practice Address - State:CA
Practice Address - Zip Code:95453-5018
Practice Address - Country:US
Practice Address - Phone:707-263-0101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-22
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34981152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist