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Organization

BOARDMAN FAMILY EYE CARE PC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
AVERY BOARDMAN OD (OWNER)
(570) 265-3668
Entity
Organization

Contact information

Practice address
889 CRAFTMASTER ROAD, WYSOX, PA 18854-0000
(570) 265-3668
(570) 265-8936
Mailing address
889 CRAFTMASTER ROAD, PO BOX 331, WYSOX, PA 18854-0000
(570) 265-3668
(570) 265-8936

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OEG000896
PA
332B00000X
Durable Medical Equipment & Medical Supplies
OEG000896
PA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
DR8207
MEDICARE RAILROAD
PA
Enumeration date
01/09/2008
Last updated
10/24/2011
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