Individual
DR. KENNETH ANDREW BOYLE SR.
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
7875 JOHNNY CAKE RIDGE RD, GREAT LAKES MALL, MENTOR, OH 44060-5529
(440) 255-2176
(440) 255-1094
Mailing address
7875 JOHNNY CAKE RIDGE RD, GREAT LAKES MALL, MENTOR, OH 44060-5529
(440) 255-2176
(440) 255-1094
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2758
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0002124
—
OH
Enumeration date
05/10/2006
Last updated
07/08/2007
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