Provider Demographics
NPI:1235950023
Name:BOYLES, DONALD JOE
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:JOE
Last Name:BOYLES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23106 US 19 N
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33765-1849
Mailing Address - Country:US
Mailing Address - Phone:727-724-3801
Mailing Address - Fax:727-724-9034
Practice Address - Street 1:23106 US 19 N
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33765-1849
Practice Address - Country:US
Practice Address - Phone:727-724-3801
Practice Address - Fax:727-724-9034
Is Sole Proprietor?:No
Enumeration Date:2024-10-23
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDO7411156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician