Healthcare Provider Details

I. General information

NPI: 1093222069
Provider Name (Legal Business Name): RONALD F BOYLES OD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2017
Last Update Date: 03/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 S AMITY RD STE A
CONWAY AR
72032-8106
US

IV. Provider business mailing address

5312 W 41ST ST
TULSA OK
74107-6110
US

V. Phone/Fax

Practice location:
  • Phone: 501-388-2020
  • Fax:
Mailing address:
  • Phone: 918-895-1700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: RONALD BOYLES
Title or Position: INSURANCE SPECIALIST
Credential: OD
Phone: 501-388-2020