Provider Demographics
NPI:1255781068
Name:BOYLE, BRADLEY (OD)
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:
Last Name:BOYLE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1310 1ST ST W
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:IA
Mailing Address - Zip Code:50644-2316
Mailing Address - Country:US
Mailing Address - Phone:319-334-6087
Mailing Address - Fax:319-334-6488
Practice Address - Street 1:1310 1ST ST W
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:IA
Practice Address - Zip Code:50644
Practice Address - Country:US
Practice Address - Phone:319-334-6087
Practice Address - Fax:319-334-6488
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-13
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA081562152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist