Provider Demographics
NPI:1952570145
Name:BOYD VISION CARE LLC
Entity Type:Organization
Organization Name:BOYD VISION CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WESLEY
Authorized Official - Middle Name:D
Authorized Official - Last Name:BOYD
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:865-724-6512
Mailing Address - Street 1:800 TIFFANY BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-1807
Mailing Address - Country:US
Mailing Address - Phone:800-940-0389
Mailing Address - Fax:866-241-2815
Practice Address - Street 1:1116 BLINKEN ST
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37932-2584
Practice Address - Country:US
Practice Address - Phone:865-724-6512
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-21
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALT69140Medicare UPIN