Provider Demographics
NPI:1295736916
Name:BOYER, DAVID S (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:S
Last Name:BOYER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1245 WILSHIRE BLVD STE 380
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90017-4886
Mailing Address - Country:US
Mailing Address - Phone:213-483-8810
Mailing Address - Fax:213-975-9118
Practice Address - Street 1:1245 WILSHIRE BLVD STE 380
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-4886
Practice Address - Country:US
Practice Address - Phone:213-483-8810
Practice Address - Fax:213-975-9118
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG25107207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G251070Medicaid
CAW3452OtherMEDICARE PTAN
CAWG25107AMedicare PIN
CAWG25107BMedicare PIN
CA00G251070Medicaid
CAWG25107JMedicare PIN
CAW3452OtherMEDICARE PTAN
CAWG25107CMedicare PIN