Provider Demographics
NPI:1669670063
Name:BOYETTE, BRITTANY B (OD)
Entity Type:Individual
Prefix:DR
First Name:BRITTANY
Middle Name:B
Last Name:BOYETTE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1950 OLD GALLOWS RD STE 520
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3970
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:571-223-6780
Practice Address - Street 1:305 E KIEHL AVE
Practice Address - Street 2:
Practice Address - City:SHERWOOD
Practice Address - State:AR
Practice Address - Zip Code:72120-2921
Practice Address - Country:US
Practice Address - Phone:501-835-3937
Practice Address - Fax:501-835-2040
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-06
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2586152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR49997OtherAR BLUECROSS BLUE SHIELD
AR166521722Medicaid
AR49997B171OtherAR BLUECROSS BLUE SHIELD
AR49997F895OtherAR BLUECROSS BLUE SHIELD
AR49997F895OtherAR BLUECROSS BLUE SHIELD
AR49997Medicare PIN
AR49997B171OtherAR BLUECROSS BLUE SHIELD
AR0179280002Medicare NSC
AR49997B171Medicare PIN
AR49997Medicare PIN