Healthcare Provider Details

I. General information

NPI: 1427044072
Provider Name (Legal Business Name): KENNETH ANDREW BOYLE JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 06/14/2023
Certification Date: 06/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2250 N BANK DR
UPPER ARLINGTON OH
43220-5420
US

IV. Provider business mailing address

2250 N BANK DR
UPPER ARLINGTON OH
43220-5420
US

V. Phone/Fax

Practice location:
  • Phone: 614-451-7550
  • Fax: 614-451-8642
Mailing address:
  • Phone: 614-451-7550
  • Fax: 614-451-8642

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number35.067552
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: