Provider Demographics
NPI:1366461246
Name:BOYLE, FARIN GEORGE (OD, BA, AAS)
Entity Type:Individual
Prefix:DR
First Name:FARIN
Middle Name:GEORGE
Last Name:BOYLE
Suffix:
Gender:M
Credentials:OD, BA, AAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5106 SW 198TH TER
Mailing Address - Street 2:
Mailing Address - City:SOUTHWEST RANCHES
Mailing Address - State:FL
Mailing Address - Zip Code:33332-1015
Mailing Address - Country:US
Mailing Address - Phone:954-257-0763
Mailing Address - Fax:
Practice Address - Street 1:18263 PINES BLVD
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33029-1419
Practice Address - Country:US
Practice Address - Phone:954-433-1234
Practice Address - Fax:954-433-1233
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2018-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC003758152W00000X
GAOPT001988152W00000X
NY006647152W00000X
HIOD-599152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL620781200Medicaid
FL620781200Medicaid