Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 18003549 | IN |
N | 152W00000X | Optometrist | 5808 | OH |
NPI | 1013171743 |
---|---|
Provider Name | Dr. Lacy Ann Boggs |
First Address | Lebanon, IN 46052-2590 |
Second Address | Lebanon, IN 46052-2590 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2008 |
Last Update Date | 28/06/2011 |