Provider Demographics
NPI:1750619037
Name:BOYD OPTOMETRIC, INC.
Entity type:Organization
Organization Name:BOYD OPTOMETRIC, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMISON
Authorized Official - Middle Name:TAYLOR
Authorized Official - Last Name:BOYD
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:217-728-4451
Mailing Address - Street 1:902 S COURT ST
Mailing Address - Street 2:SUITE #1
Mailing Address - City:TUSCOLA
Mailing Address - State:IL
Mailing Address - Zip Code:61953-2000
Mailing Address - Country:US
Mailing Address - Phone:217-253-2220
Mailing Address - Fax:217-253-2292
Practice Address - Street 1:902 S COURT ST
Practice Address - Street 2:SUITE #1
Practice Address - City:TUSCOLA
Practice Address - State:IL
Practice Address - Zip Code:61953-2000
Practice Address - Country:US
Practice Address - Phone:217-253-2220
Practice Address - Fax:217-253-2292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-25
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL047008823152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty