Provider Demographics
NPI:1639696073
Name:MOFFITT, BOYCE N (OPTICIAN, ABOC)
Entity Type:Individual
Prefix:
First Name:BOYCE
Middle Name:N
Last Name:MOFFITT
Suffix:
Gender:M
Credentials:OPTICIAN, ABOC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1205 N DEARBORN ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-2213
Mailing Address - Country:US
Mailing Address - Phone:312-943-2020
Mailing Address - Fax:312-275-7189
Practice Address - Street 1:12 E 1ST ST
Practice Address - Street 2:
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-4102
Practice Address - Country:US
Practice Address - Phone:630-325-2020
Practice Address - Fax:312-275-7189
Is Sole Proprietor?:No
Enumeration Date:2017-08-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician