MEDICARE: DR. GORDON R 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	2070	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	35-2055953	OTHER	IN	EMPLOYER TAX ID
2	DMERC	OTHER	IN	DURABLE MED. EQUIP. #
3	U25862	OTHER	IN	VSP
4	410048352	OTHER	IN	PALMETTO GBA
5	0474130001	OTHER	IN	DMERC

General Provider Information

NPI Number	:	1427052216
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GORDON R BOYD O.D.

Provider Business Mailing Address
First Line	:	1485 S GRANT AVE
Second Line	:	STE A
City	:	CRAWFORDSVILLE
State	:	IN
Zip	:	47933-3329
Country	:	US
Telephone Number	:	765-362-3209
Fax Number	:	765-364-9233

Provider Business Practice Location Address
First Line	:	1485 S GRANT AVE
Second Line	:	STE A
City	:	CRAWFORDSVILLE
State	:	IN
Zip	:	47933-3329
Country	:	US
Telephone Number	:	765-362-3209
Fax Number	:	765-364-9233

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

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	07/12/2017

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