Provider Demographics
NPI:1376571679
Name:BOYD, CAROLEE ROSE (OD)
Entity Type:Individual
Prefix:DR
First Name:CAROLEE
Middle Name:ROSE
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 1:41 S WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12801-3313
Mailing Address - Country:US
Mailing Address - Phone:518-792-2345
Mailing Address - Fax:518-792-1361
Practice Address - Street 1:41 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12801-3313
Practice Address - Country:US
Practice Address - Phone:518-792-2345
Practice Address - Fax:518-792-1361
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV005547-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY4696250001Medicare NSC
NYU52578Medicare UPIN
NYDD0681Medicare PIN