Individual
DR. GORDON R BOYD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
1485 S GRANT AVE, STE A, CRAWFORDSVILLE, IN 47933-3329
(765) 362-3209
(765) 364-9233
Mailing address
1485 S GRANT AVE, STE A, CRAWFORDSVILLE, IN 47933-3329
(765) 362-3209
(765) 364-9233
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2070
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0474130001
DMERC
IN
01
—
35-2055953
EMPLOYER TAX ID
IN
01
—
410048352
PALMETTO GBA
IN
01
—
DMERC
DURABLE MED. EQUIP. #
IN
01
—
U25862
VSP
IN
Enumeration date
06/09/2005
Last updated
07/12/2017
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