Provider Demographics
NPI:1649443474
Name:BOYD, WESLEY D (OD)
Entity type:Individual
Prefix:DR
First Name:WESLEY
Middle Name:D
Last Name:BOYD
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 1:1508 CUTTERS RUN LN
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37932-2495
Mailing Address - Country:US
Mailing Address - Phone:865-724-6512
Mailing Address - Fax:
Practice Address - Street 1:1508 CUTTERS RUN LN
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37932-2495
Practice Address - Country:US
Practice Address - Phone:865-724-6512
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-13
Last Update Date:2015-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3026152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALT69140Medicare PIN