Provider Demographics
NPI:1619106721
Name:STEVEN T BOYLES, OD PC
Entity Type:Organization
Organization Name:STEVEN T BOYLES, OD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:T
Authorized Official - Last Name:BOYLES
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:770-489-7595
Mailing Address - Street 1:7001 CONCOURSE PKWY
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30134-4549
Mailing Address - Country:US
Mailing Address - Phone:770-489-7596
Mailing Address - Fax:770-489-7695
Practice Address - Street 1:7001 CONCOURSE PKWY
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30134-4549
Practice Address - Country:US
Practice Address - Phone:770-489-7595
Practice Address - Fax:770-489-7695
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-09
Last Update Date:2009-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1435-T152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA41ZCCSDMedicare PIN