Healthcare Provider Details

I. General information

NPI: 1720078397
Provider Name (Legal Business Name): MIRIAM S BOYD OD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2005
Last Update Date: 03/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

609 DUBOIS ST
VINCENNES IN
47591-1048
US

IV. Provider business mailing address

609 DUBOIS ST
VINCENNES IN
47591-1048
US

V. Phone/Fax

Practice location:
  • Phone: 812-882-8500
  • Fax: 812-882-7785
Mailing address:
  • Phone: 812-882-8500
  • Fax: 812-882-7785

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number18001378
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: