Provider Demographics
NPI:1629176581
Name:BOATWRIGHT, LAYLE DEAN (OD)
Entity Type:Individual
Prefix:DR
First Name:LAYLE
Middle Name:DEAN
Last Name:BOATWRIGHT
Suffix:
Gender:F
Credentials:OD
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Mailing Address - Street 1:15031 TIMBER RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:LOXLEY
Mailing Address - State:AL
Mailing Address - Zip Code:36551-5413
Mailing Address - Country:US
Mailing Address - Phone:251-964-4629
Mailing Address - Fax:251-679-4109
Practice Address - Street 1:1095 INDUSTRIAL PKWY
Practice Address - Street 2:
Practice Address - City:SARALAND
Practice Address - State:AL
Practice Address - Zip Code:36571-3719
Practice Address - Country:US
Practice Address - Phone:251-675-0841
Practice Address - Fax:251-679-4109
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ALS884T442152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist