Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1700X | Ocularist | 27-3468101 | NC |
N | 225000000X | Orthotic Fitter |
NPI | 1770701526 |
---|---|
Provider Name | Michael William Boyd |
First Address | Burlington, NC 27215-6846 |
Second Address | Burlington, NC 27215-6846 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2007 |
Last Update Date | 18/07/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
023UX | BLUE CROSS BULE SHIELD (01) | NC |
7795511 | (05) | NC |