MEDICARE: JAMISON T BOYD O.D.

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
1	152W00000X	Optometrist	046008823	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	410047783	OTHER	IL	MEDICARE RR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	05815176	OTHER	IL	BLUE CROSS & BLUE SHIELD
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1326008137
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMISON T BOYD O.D.

Provider Business Mailing Address
First Line	:	902 S COURT ST
Second Line	:	SUITE #1
City	:	TUSCOLA
State	:	IL
Zip	:	61953
Country	:	US
Telephone Number	:	217-253-2220
Fax Number	:	217-253-2292

Provider Business Practice Location Address
First Line	:	902 S COURT ST
Second Line	:	SUITE #1
City	:	TUSCOLA
State	:	IL
Zip	:	61953
Country	:	US
Telephone Number	:	217-235-2220
Fax Number	:	217-253-2292

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/24/2006
Last Update Date	:	02/13/2017

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