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Contact Information

AVERY B BOARDMAN, OD
889 CRAFTMASTER ROAD
WYSOX, PA18854-0000
 Phone: 570-265-3668
 Fax: 570-265-8936
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Optometrist

152W00000X 41 Optometry
Indicates primary specialty

NPI Profile & details for AVERY B BOARDMAN · (Male)

NPI Number 1073603718
Status Active
Credentials OD (Doctor of Optometry)
Entity Individual
Enumeration date 10/13/2006
Last updated 03/23/2011 - About 15 years ago
Sole proprietor 1 No
Identifiers
  • PA License # OEG000896
  • PA Medicaid 0012690190004
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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