Provider Demographics
NPI:1922237015
Name:GLENN A. BOYD, O.D. ,P.A.
Entity Type:Organization
Organization Name:GLENN A. BOYD, O.D. ,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:O.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:A
Authorized Official - Last Name:BOYD
Authorized Official - Suffix:
Authorized Official - Credentials:OD, PA
Authorized Official - Phone:817-557-3937
Mailing Address - Street 1:1560 HIGHWAY 287 N
Mailing Address - Street 2:STE. 300
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-8824
Mailing Address - Country:US
Mailing Address - Phone:817-557-3937
Mailing Address - Fax:
Practice Address - Street 1:1560 HIGHWAY 287 N
Practice Address - Street 2:STE. 300
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-8824
Practice Address - Country:US
Practice Address - Phone:817-557-3937
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-09
Last Update Date:2009-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3321TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXT12316Medicare UPIN
TX00873WMedicare PIN