Provider Demographics
NPI:1285203547
Name:BOYNTON, KAILEY THOMAS (OD)
Entity Type:Individual
Prefix:
First Name:KAILEY
Middle Name:THOMAS
Last Name:BOYNTON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:KAILEY
Other - Middle Name:ELISE
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15 IRIS LN
Mailing Address - Street 2:
Mailing Address - City:CROSSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38555-7528
Mailing Address - Country:US
Mailing Address - Phone:931-456-2728
Mailing Address - Fax:931-456-5446
Practice Address - Street 1:15 IRIS LN
Practice Address - Street 2:
Practice Address - City:CROSSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38555-7528
Practice Address - Country:US
Practice Address - Phone:931-456-2728
Practice Address - Fax:931-456-5446
Is Sole Proprietor?:No
Enumeration Date:2021-06-22
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPENDING152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist