Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 152W00000X | Optometrist | 662 | NV |
Y | 152W00000X | Optometrist | 7313T | TX |
NPI | 1003068800 |
---|---|
Provider Name | Dillon Lee Boynton |
First Address | El Paso, TX 79907-1275 |
Second Address | El Paso, TX 79907-1275 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2008 |
Last Update Date | 27/02/2018 |