Healthcare Provider Details

I. General information

NPI: 1982230751
Provider Name (Legal Business Name): BOYD GUBLER OD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2020
Last Update Date: 03/12/2020
Certification Date: 03/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

614 W 300 S
HEYBURN ID
83336-9784
US

IV. Provider business mailing address

614 W 300 S
HEYBURN ID
83336-9784
US

V. Phone/Fax

Practice location:
  • Phone: 801-889-8420
  • Fax:
Mailing address:
  • Phone: 801-889-8420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: BOYD GUBLER
Title or Position: PRESIDENT
Credential:
Phone: 801-889-8420