Provider Demographics
NPI:1235269861
Name:BROYLES, DONNY R (OD)
Entity Type:Individual
Prefix:
First Name:DONNY
Middle Name:R
Last Name:BROYLES
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:31573 RANCHO PUEBLO RD
Mailing Address - Street 2:STE 101
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592-4835
Mailing Address - Country:US
Mailing Address - Phone:951-302-5580
Mailing Address - Fax:951-302-5581
Practice Address - Street 1:31685 US HIGHWAY 79 S
Practice Address - Street 2:SUITE A
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92592-2872
Practice Address - Country:US
Practice Address - Phone:951-302-5580
Practice Address - Fax:951-302-5581
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10290T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU52026Medicare UPIN