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NPI Code Detail

MEDICARE: KAILEY THOMAS BOYNTON OD

MEDICARE: KAILEY THOMAS BOYNTON OD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometristPENDINGTN

General Provider Information

NPI Number : 1285203547
Entity Type Code : Individual
Provider Name (Legal Business Name) : KAILEY THOMAS BOYNTON OD
Provider Business Mailing Address
First Line : 15 IRIS LN
Second Line :
City : CROSSVILLE
State : TN
Zip : 38555-7528
Country : US
Telephone Number : 931-456-2728
Fax Number : 931-456-5446
Provider Business Practice Location Address
First Line : 15 IRIS LN
Second Line :
City : CROSSVILLE
State : TN
Zip : 38555-7528
Country : US
Telephone Number : 931-456-2728
Fax Number : 931-456-5446
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/22/2021
Last Update Date : 10/27/2021

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Directions to “ KAILEY THOMAS BOYNTON OD” Practice Location

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