Provider Demographics
NPI:1235141342
Name:BOYLE, JOHN W (OD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:W
Last Name:BOYLE
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 1:3 W OLIVE ST
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18508-2572
Mailing Address - Country:US
Mailing Address - Phone:570-558-5566
Mailing Address - Fax:570-558-3535
Practice Address - Street 1:3 W OLIVE ST
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18508-2572
Practice Address - Country:US
Practice Address - Phone:570-558-5566
Practice Address - Fax:570-558-3535
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000808152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered152W00000XEye and Vision Services ProvidersOptometrist
Not Answered152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
20967OtherGEISINGER HEALTH PLAN
PA1906910OtherHIGHMARK BLUE SHIELD
PA820633OtherFIRST PRIORITY
20967OtherGEISINGER HEALTH PLAN
U26542Medicare UPIN