Provider Demographics
NPI:1013977230
Name:BOYLAND, JAMES P (O D)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:P
Last Name:BOYLAND
Suffix:
Gender:M
Credentials:O D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8614 WESTWOOD CENTER DR FL 9
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-2442
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:703-991-0514
Practice Address - Street 1:4605 KIRKWOOD HWY STE A
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-5005
Practice Address - Country:US
Practice Address - Phone:302-999-7171
Practice Address - Fax:302-993-7863
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE130001261152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE01114Medicaid
DE161525705OtherBCBS
PAAMS0407533OtherDEA
DE161525705OtherBCBS
PAAMS0407533OtherDEA