Healthcare Provider Details

I. General information

NPI: 1346245453
Provider Name (Legal Business Name): MATTHEW M BOYER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2005
Last Update Date: 09/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 NW 1ST ST
EVANSVILLE IN
47708-1259
US

IV. Provider business mailing address

101 N. W. FIRST ST. SUITE 112
EVANSVILLE IN
47708-0396
US

V. Phone/Fax

Practice location:
  • Phone: 812-426-2020
  • Fax: 812-426-2828
Mailing address:
  • Phone: 812-426-2020
  • Fax: 812-426-2828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number01045185
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: