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General NPI Number Information
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NPI Number | 1477042703
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Entity Type | Organization
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Legal Business Name | GLENN A. BOYD, O.D. ,P.A.
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Dates
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Enumeration Date | 05/02/2018
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Last Update Date | 05/02/2018
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Provider Practice Location Address
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Address Line | 700 SILKEN XING STE 2002
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City | MIDLOTHIAN
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State | TX
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Zip | 76065-5595
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Country | US
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Telephone | 972-723-2727
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Fax | 972-775-6539
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Provider Business Mailing Address
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Address Line | 1560 HIGHWAY 287 N STE 300
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City | MANSFIELD
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State | TX
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Zip | 76063-8824
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Country | US
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Telephone | 817-557-3937
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Fax | 817-473-0950
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Authorized Official
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Title or Position | MANAGER
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Name | BRANDY LASATER
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Credential |
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Telephone | 817-557-3937
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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 | 3321TG
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License Number State | TX
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