Provider Demographics
NPI:1790827939
Name:BOSWELL, EVA KAREN (OD)
Entity Type:Individual
Prefix:DR
First Name:EVA
Middle Name:KAREN
Last Name:BOSWELL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:645 E LEMON AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE ALFRED
Mailing Address - State:FL
Mailing Address - Zip Code:33850-2225
Mailing Address - Country:US
Mailing Address - Phone:863-318-9966
Mailing Address - Fax:
Practice Address - Street 1:7450 CYPRESS GARDENS BLVD
Practice Address - Street 2:WAL-MART OPTICAL
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33884-6200
Practice Address - Country:US
Practice Address - Phone:863-318-9966
Practice Address - Fax:863-318-0348
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2013-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC001799152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist