Provider Demographics
NPI:1568627305
Name:GUBLER, BOYD KELLY (OD)
Entity Type:Individual
Prefix:
First Name:BOYD
Middle Name:KELLY
Last Name:GUBLER
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:PO BOX 5
Mailing Address - Street 2:
Mailing Address - City:HEYBURN
Mailing Address - State:ID
Mailing Address - Zip Code:83336-0005
Mailing Address - Country:US
Mailing Address - Phone:801-889-8420
Mailing Address - Fax:
Practice Address - Street 1:614 W 300 S
Practice Address - Street 2:
Practice Address - City:HEYBURN
Practice Address - State:ID
Practice Address - Zip Code:83336-9784
Practice Address - Country:US
Practice Address - Phone:801-889-8420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-22
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7060853-8908152W00000X
IDODP-100429152WC0802X
UT7060853-9934152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty