Provider Demographics
NPI:1558670760
Name:BRUCE BOYLE, OD. LLC
Entity Type:Organization
Organization Name:BRUCE BOYLE, OD. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:BRUCE
Authorized Official - Last Name:BOYLE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:316-260-6280
Mailing Address - Street 1:2757 S SENECA ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67217-2862
Mailing Address - Country:US
Mailing Address - Phone:316-260-6280
Mailing Address - Fax:316-665-6806
Practice Address - Street 1:2757 S SENECA ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67217-2862
Practice Address - Country:US
Practice Address - Phone:316-260-6280
Practice Address - Fax:316-665-6806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-05
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1473-3152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS545740OtherCOVENTRY
KS5062OtherPREFERRED HEALTH SYSTEMS
KS100363120-EMedicaid
KSKS4733OtherEYE MED
KSKS4733OtherEYE MED
KS5062OtherPREFERRED HEALTH SYSTEMS
KS6487690001Medicare NSC