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General NPI Number Information
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NPI Number | 1003361197
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Entity Type | Organization
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Legal Business Name | BRUCE BOYLE OD INC
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Dates
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Enumeration Date | 08/18/2016
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Last Update Date | 08/18/2016
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Provider Practice Location Address
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Address Line | 2757 S SENECA ST
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City | WICHITA
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State | KS
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Zip | 67217-2862
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Country | US
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Telephone | 316-260-6280
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Fax | 316-665-6806
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Provider Business Mailing Address
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Address Line | 2757 S SENECA ST
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City | WICHITA
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State | KS
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Zip | 67217-2862
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Country | US
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Telephone | 316-260-6280
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Fax | 316-665-6806
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Authorized Official
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Title or Position | OWNER
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Name | DR. BRUCE BOYLE
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Credential | O.D
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Telephone | 316-260-6280
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 1473-3
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License Number State | KS
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