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
Update your record
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