Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 3982 / T366 | OH |
NPI | 1013005917 |
---|---|
Provider Name | Dr. Roman Boiwka |
First Address | Amherst, OH 44001-3430 |
Second Address | Avon, OH 44011-1069 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/10/2006 |
Last Update Date | 08/07/2007 |