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General NPI Number Information
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NPI Number | 1619106721
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Entity Type | Organization
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Legal Business Name | STEVEN T BOYLES, OD PC
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Dates
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Enumeration Date | 07/09/2009
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Last Update Date | 07/09/2009
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Provider Practice Location Address
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Address Line | 7001 CONCOURSE PKWY
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City | DOUGLASVILLE
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State | GA
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Zip | 30134-4549
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Country | US
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Telephone | 770-489-7595
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Fax | 770-489-7695
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Provider Business Mailing Address
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Address Line | 7001 CONCOURSE PKWY
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City | DOUGLASVILLE
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State | GA
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Zip | 30134-4549
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Country | US
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Telephone | 770-489-7596
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Fax | 770-489-7695
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. STEVEN T BOYLES
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Credential | OD
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Telephone | 770-489-7595
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152WC0802X
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Taxonomy Name | Corneal and Contact Management Optometrist
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License Number | 1435-T
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License Number State | GA
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