Provider Demographics
NPI:1093985897
Name:FIONA S BOAK, OD, PSC
Entity Type:Organization
Organization Name:FIONA S BOAK, OD, PSC
Other - Org Name:FIONA C SLONE, OD PSC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:FIONA
Authorized Official - Middle Name:S
Authorized Official - Last Name:BOAK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:502-326-3114
Mailing Address - Street 1:3706 DIANN MARIE RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40241-3818
Mailing Address - Country:US
Mailing Address - Phone:502-326-3114
Mailing Address - Fax:502-326-9751
Practice Address - Street 1:3706 DIANN MARIE RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40241-3818
Practice Address - Country:US
Practice Address - Phone:502-326-3114
Practice Address - Fax:502-326-9751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-07
Last Update Date:2013-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1423DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY77001444Medicaid
KYV05419Medicare UPIN
KY9678Medicare PIN