Provider Demographics
NPI:1639405194
Name:BOYLES, ALICIA (OD)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:BOYLES
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44075 PIPELINE PLZ
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-5889
Mailing Address - Country:US
Mailing Address - Phone:703-724-9948
Mailing Address - Fax:703-724-9949
Practice Address - Street 1:44075 PIPELINE PLZ
Practice Address - Street 2:
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-5889
Practice Address - Country:US
Practice Address - Phone:703-724-9948
Practice Address - Fax:703-724-9949
Is Sole Proprietor?:No
Enumeration Date:2009-10-19
Last Update Date:2009-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000453152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAU67793Medicare UPIN
VA000C86F71Medicare PIN