Provider Demographics
NPI:1346309234
Name:BOYLE, RICHARD B (OD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:B
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 1:1390 N MCDOWELL BLVD STE F
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94954-7104
Mailing Address - Country:US
Mailing Address - Phone:707-795-7433
Mailing Address - Fax:707-795-7359
Practice Address - Street 1:1390 N MCDOWELL BLVD STE F
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94954-7104
Practice Address - Country:US
Practice Address - Phone:707-795-7433
Practice Address - Fax:707-795-7359
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5820T152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0058200Medicaid
CA0862880001Medicare NSC
CASD0058200Medicare ID - Type Unspecified
CAT10131Medicare UPIN