Provider Demographics
NPI:1255856969
Name:BOYD, DANIELLE ELISE CHRISTINA (OD)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:ELISE CHRISTINA
Last Name:BOYD
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 KERN CREEK WAY
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:CA
Mailing Address - Zip Code:95361-9653
Mailing Address - Country:US
Mailing Address - Phone:209-988-0030
Mailing Address - Fax:
Practice Address - Street 1:190 S MAAG AVE STE G
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:CA
Practice Address - Zip Code:95361-9622
Practice Address - Country:US
Practice Address - Phone:209-847-1121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-03
Last Update Date:2017-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33809152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist