Provider Demographics
NPI:1982230751
Name:BOYD GUBLER OD PC
Entity Type:Organization
Organization Name:BOYD GUBLER OD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BOYD
Authorized Official - Middle Name:
Authorized Official - Last Name:GUBLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-889-8420
Mailing Address - Street 1:614 W 300 S
Mailing Address - Street 2:
Mailing Address - City:HEYBURN
Mailing Address - State:ID
Mailing Address - Zip Code:83336-9784
Mailing Address - Country:US
Mailing Address - Phone:801-889-8420
Mailing Address - Fax:
Practice Address - Street 1:614 W 300 S
Practice Address - Street 2:
Practice Address - City:HEYBURN
Practice Address - State:ID
Practice Address - Zip Code:83336-9784
Practice Address - Country:US
Practice Address - Phone:801-889-8420
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-12
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty