Provider Demographics
NPI:1235161654
Name:BOILINI, JAMES J (OD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:J
Last Name:BOILINI
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 1:99696 OVERSEAS HWY
Mailing Address - Street 2:
Mailing Address - City:KEY LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33037-2432
Mailing Address - Country:US
Mailing Address - Phone:305-451-1481
Mailing Address - Fax:305-451-5077
Practice Address - Street 1:99696 OVERSEAS HWY
Practice Address - Street 2:
Practice Address - City:KEY LARGO
Practice Address - State:FL
Practice Address - Zip Code:33037-2432
Practice Address - Country:US
Practice Address - Phone:305-451-1481
Practice Address - Fax:305-451-5077
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2009-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC001208152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL084828000Medicaid
FL408580804OtherMEDICARE RR
FL408580804OtherMEDICARE RR
FL0896660001Medicare NSC
FL19276Medicare PIN