Provider Demographics
NPI:1235108655
Name:BOYLES, RONALD FRANKLIN (O D)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:FRANKLIN
Last Name:BOYLES
Suffix:
Gender:M
Credentials:O D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 S AMITY RD STE A
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72032-8106
Mailing Address - Country:US
Mailing Address - Phone:501-388-2020
Mailing Address - Fax:
Practice Address - Street 1:1100 S AMITY RD STE A
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72032-8106
Practice Address - Country:US
Practice Address - Phone:501-388-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2018-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2211152WC0802X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR104547722Medicaid
AR826540734OtherRAILROAD MEDICARE GBA
AR0795310001OtherPALMETTO MEDICARE
AR826540734OtherRAILROAD MEDICARE GBA
AR710538235OtherTAX ID NUMBER FOR OTHER
AR0795310001OtherPALMETTO MEDICARE