Provider Demographics
NPI:1497032882
Name:BOSTWICK, PAUL LAWRENCE (OD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:LAWRENCE
Last Name:BOSTWICK
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:242 WIGET LN
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-3410
Mailing Address - Country:US
Mailing Address - Phone:925-588-1432
Mailing Address - Fax:
Practice Address - Street 1:2801 YGNACIO VALLEY RD STE A
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-3500
Practice Address - Country:US
Practice Address - Phone:925-933-2600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-14
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15153TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist