Provider Demographics
NPI:1689964090
Name:RONALD F. BOYLES O.D., P.A.
Entity Type:Organization
Organization Name:RONALD F. BOYLES O.D., P.A.
Other - Org Name:DR. RONALD FRANKLIN BOYLES O D
Other - Org Type:Other Name
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:A
Authorized Official - Last Name:BOYLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-758-9500
Mailing Address - Street 1:2520 CRESTWOOD RD
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72116-7623
Mailing Address - Country:US
Mailing Address - Phone:501-758-9500
Mailing Address - Fax:501-753-4311
Practice Address - Street 1:2520 CRESTWOOD RD
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72116-7623
Practice Address - Country:US
Practice Address - Phone:501-758-9500
Practice Address - Fax:501-753-4311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-19
Last Update Date:2011-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2211152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR104547722Medicaid
AR104547722Medicaid