Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 5820T | CA |
NPI | 1346309234 |
---|---|
Provider Name | Dr. Richard B Boyle |
First Address | Petaluma, CA 94954-7104 |
Second Address | Petaluma, CA 94954-7104 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/12/2006 |
Last Update Date | 23/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
SD0058200 | (05) | CA |
T10131 | (02) | CA |